Provider Demographics
NPI:1467037366
Name:LIAO, MEI FANG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MEI FANG
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5049
Mailing Address - Country:US
Mailing Address - Phone:347-410-2366
Mailing Address - Fax:
Practice Address - Street 1:863 50TH ST APT M6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2417
Practice Address - Country:US
Practice Address - Phone:347-240-8482
Practice Address - Fax:718-878-5708
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346324-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily