Healthcare Provider Details

I. General information

NPI: 1780636258
Provider Name (Legal Business Name): VICTORIA YOUNG RYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 WOOSTER LN SUITE 1
SANIBEL FL
33957-3223
US

IV. Provider business mailing address

2323 WOOSTER LN SUITE 1
SANIBEL FL
33957-3223
US

V. Phone/Fax

Practice location:
  • Phone: 239-472-6877
  • Fax: 239-472-6870
Mailing address:
  • Phone: 239-472-6877
  • Fax: 239-472-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: