MEDICARE: SEAN JAMES RYAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	724561	NY
2	363LF0000X	Family Nurse Practitioner	F345408	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467090589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN JAMES RYAN RN

Provider Business Mailing Address
First Line	:	11 ASPEN RD
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-6234
Country	:	US
Telephone Number	:	914-618-0907
Fax Number	:	855-703-7570

Provider Business Practice Location Address
First Line	:	111 CLOCK TOWER CMNS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	855-703-7570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	04/02/2026

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