Healthcare Provider Details

I. General information

NPI: 1770138158
Provider Name (Legal Business Name): RYAN ANTHONY WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MOSELEY AVE
PALATKA FL
32177-4937
US

IV. Provider business mailing address

504 MOSELEY AVE
PALATKA FL
32177-4937
US

V. Phone/Fax

Practice location:
  • Phone: 386-562-0170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: