Provider Demographics
NPI:1588188700
Name:KUANG, EVELYN (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KUANG
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:KUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, PMHNP-BC
Mailing Address - Street 1:125 WALKER STREET FLOOR 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-226-8866
Mailing Address - Fax:212-226-2289
Practice Address - Street 1:268 CANAL STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1011
Practice Address - Country:US
Practice Address - Phone:212-941-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705326-1163WP0808X
NYF402293-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05157415Medicaid