Provider Demographics
NPI:1295086833
Name:YANG, CANNEY SHAO (LMT)
Entity type:Individual
Prefix:
First Name:CANNEY
Middle Name:SHAO
Last Name:YANG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GRATTAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2409
Mailing Address - Country:US
Mailing Address - Phone:516-395-0563
Mailing Address - Fax:
Practice Address - Street 1:59 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1035
Practice Address - Country:US
Practice Address - Phone:516-395-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026077-4225700000X
NY026077-2225700000X
NY026077-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist