MEDICARE: MS. CLARA CHEUNG R.D. C.D.E.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	003676	NY
2	133V00000X	Registered Dietitian	003676	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003676	OTHER	NY	CERTIFIED DIETITIAN-NUTRITIONIST

General Provider Information

NPI Number	:	1871797563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLARA CHEUNG R.D. C.D.E.

Provider Business Mailing Address
First Line	:	3712 PRINCE ST STE 5B
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4650
Country	:	US
Telephone Number	:	212-966-3829
Fax Number	:	718-228-8917

Provider Business Practice Location Address
First Line	:	3712 PRINCE ST STE 5B
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4650
Country	:	US
Telephone Number	:	718-886-7856
Fax Number	:	718-228-8917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	12/17/2024

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