Healthcare Provider Details

I. General information

NPI: 1568924058
Provider Name (Legal Business Name): BRIENNE RYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

700 BUCKWALTER TOWNE BLVD
BLUFFTON SC
29909
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-1000
  • Fax: 203-276-1000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number96914
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: