Healthcare Provider Details

I. General information

NPI: 1447888094
Provider Name (Legal Business Name): DANIEL RYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HEALD WAY STE 100
THE VILLAGES FL
32163-6000
US

IV. Provider business mailing address

340 HEALD WAY STE 100
THE VILLAGES FL
32163-6000
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-1919
  • Fax:
Mailing address:
  • Phone: 352-259-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4756
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.006042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: