Provider Demographics
NPI:1871797563
Name:CHEUNG, CLARA (RD CDE)
Entity type:Individual
Prefix:MS
First Name:CLARA
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 PRINCE ST STE 5B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4650
Mailing Address - Country:US
Mailing Address - Phone:212-966-3829
Mailing Address - Fax:718-228-8917
Practice Address - Street 1:3712 PRINCE ST STE 5B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4650
Practice Address - Country:US
Practice Address - Phone:718-886-7856
Practice Address - Fax:718-228-8917
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003676133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003676OtherCERTIFIED DIETITIAN-NUTRITIONIST
NYWEY071Medicare UPIN