Provider Demographics
NPI:1649724386
Name:LIAO, LUCY (NP)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 38TH AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4264
Mailing Address - Country:US
Mailing Address - Phone:347-368-0002
Mailing Address - Fax:718-750-2947
Practice Address - Street 1:13620 38TH AVE STE 5A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4264
Practice Address - Country:US
Practice Address - Phone:347-368-0002
Practice Address - Fax:718-750-2947
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30307862363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health