Healthcare Provider Details

I. General information

NPI: 1588576375
Provider Name (Legal Business Name): NUYU SKIN BODY MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E JERICHO TPKE
MINEOLA NY
11501-2054
US

IV. Provider business mailing address

190 E JERICHO TPKE
MINEOLA NY
11501-2054
US

V. Phone/Fax

Practice location:
  • Phone: 516-774-4333
  • Fax:
Mailing address:
  • Phone: 516-774-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: RENA GHELICHKHANI
Title or Position: ACUPUNCTURIST
Credential: LA.C
Phone: 516-774-4333