Basic Information
| Provider Information | |||||||||
| NPI: | 1851774830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10305 NIGHTWIND CIR | ||||||||
| Address2: | |||||||||
| City: | CANTONMENT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325336651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505128633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3250 MARY ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331335293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059081115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9112482 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.