Provider Demographics
NPI:1164031845
Name:WANG-LAZARUS, SHY YEONG (RDN)
Entity Type:Individual
Prefix:
First Name:SHY
Middle Name:YEONG
Last Name:WANG-LAZARUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 63RD DR APT 423
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3841
Mailing Address - Country:US
Mailing Address - Phone:917-579-8374
Mailing Address - Fax:
Practice Address - Street 1:8911 63RD DR APT 423
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3841
Practice Address - Country:US
Practice Address - Phone:917-579-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered