Healthcare Provider Details

I. General information

NPI: 1164799037
Provider Name (Legal Business Name): RYAN DEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

7512 DR PHILLIPS BLVD SUITE 50, PMB514
ORLANDO FL
32819-5131
US

V. Phone/Fax

Practice location:
  • Phone: 407-245-8501
  • Fax: 407-245-8503
Mailing address:
  • Phone: 407-245-8501
  • Fax: 407-245-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME121465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: