Provider Demographics
NPI:1619699055
Name:CHEN, SIQIAN (RD)
Entity Type:Individual
Prefix:
First Name:SIQIAN
Middle Name:
Last Name:CHEN
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 1:301 MILLIKEN BLVD APT 201
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1605
Practice Address - Country:US
Practice Address - Phone:646-598-3457
Practice Address - Fax:888-370-1981
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN01180133VN1004X
MALDN6792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILDN01180OtherLICENSED DIETITIAN NUTRITIONIST
MALDN6792OtherLICENSED DIETITIAN NUTRITIONIST