Healthcare Provider Details

I. General information

NPI: 1639073687
Provider Name (Legal Business Name): RYAN CANNING CRPS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16158 S MILITARY TRL
DELRAY BEACH FL
33484-6502
US

IV. Provider business mailing address

9076 VILLA PORTOFINO CIR
BOCA RATON FL
33496-1752
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-2179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number5237-A
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: