Provider Demographics
NPI:1295571321
Name:XIAO, CHARLIE WENHAI (MSN, MBA, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:WENHAI
Last Name:XIAO
Suffix:
Gender:M
Credentials:MSN, MBA, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PARSONS BLVD
Mailing Address - Street 2:ATTN: FLUSHING HOSPITAL PSYCHIATRIC OUTPATIENT CLINIC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 E 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2804
Practice Address - Country:US
Practice Address - Phone:347-331-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406148363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health