Provider Demographics
NPI:1508583311
Name:AU, TSZ SHAN (RD)
Entity Type:Individual
Prefix:
First Name:TSZ SHAN
Middle Name:
Last Name:AU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3347 213TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1560
Mailing Address - Country:US
Mailing Address - Phone:929-777-4933
Mailing Address - Fax:888-370-1981
Practice Address - Street 1:3347 213TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1560
Practice Address - Country:US
Practice Address - Phone:929-777-4933
Practice Address - Fax:888-370-1981
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86298640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered