Healthcare Provider Details

I. General information

NPI: 1881500114
Provider Name (Legal Business Name): RYAN SI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAINT PAUL ST APT 123
BALTIMORE MD
21202-2861
US

IV. Provider business mailing address

5 HEMLOCK DR
SYOSSET NY
11791-4206
US

V. Phone/Fax

Practice location:
  • Phone: 443-977-8439
  • Fax:
Mailing address:
  • Phone: 516-851-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: