Basic Information
| Provider Information | |||||||||
| NPI: | 1922677467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | SANDY XIAO- YI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 14015B SANFORD AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183588288 | ||||||||
| FaxNumber: | 7183585265 | ||||||||
| Practice Location | |||||||||
| Address1: | 14015B SANFORD AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183588288 | ||||||||
| FaxNumber: | 7183585265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 08/19/2021 | ||||||||
| NPIReactivationDate: | 09/23/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 112665-01 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | 112665-01 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 104100000X | 112665 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.