Healthcare Provider Details

I. General information

NPI: 1609785625
Provider Name (Legal Business Name): RYAN SCHUCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SOUTH COLLEGE AVE
NEWARK DE
19713
US

IV. Provider business mailing address

29 SCOTT PL
HARTSDALE NY
10530-1003
US

V. Phone/Fax

Practice location:
  • Phone: 914-419-6181
  • Fax:
Mailing address:
  • Phone: 914-419-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: