Provider Demographics
NPI:1104129493
Name:YANG, XIAOLI W (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:XIAOLI
Middle Name:W
Last Name:YANG
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2416
Mailing Address - Country:US
Mailing Address - Phone:516-620-0677
Mailing Address - Fax:
Practice Address - Street 1:56 BROOK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2416
Practice Address - Country:US
Practice Address - Phone:516-620-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003426-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist