Healthcare Provider Details

I. General information

NPI: 1730933102
Provider Name (Legal Business Name): AMY RYCZKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OUTER DR STE LL02
DETROIT MI
48235-3461
US

IV. Provider business mailing address

3787 ALIDA AVE
ROCHESTER HILLS MI
48309-4244
US

V. Phone/Fax

Practice location:
  • Phone: 313-259-1574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: