Healthcare Provider Details

I. General information

NPI: 1285116111
Provider Name (Legal Business Name): RYAN DAVID STADNIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 WILLOWBROOK PKWY STE 300
INDIANAPOLIS IN
46205-1500
US

IV. Provider business mailing address

9615 E 148TH ST STE 1
NOBLESVILLE IN
46060-4371
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax: 317-674-0060
Mailing address:
  • Phone: 317-574-1254
  • Fax: 317-674-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043765A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: