Healthcare Provider Details

I. General information

NPI: 1821906660
Provider Name (Legal Business Name): DAYSTROM LABS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W LEGION ST
WHITEHALL MT
59759-9735
US

IV. Provider business mailing address

80 8TH AVE STE 202
NEW YORK NY
10011-0607
US

V. Phone/Fax

Practice location:
  • Phone: 646-893-4309
  • Fax: 332-334-3008
Mailing address:
  • Phone: 646-893-4309
  • Fax: 332-334-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN SULTAN
Title or Position: OWNER
Credential: MD
Phone: 646-893-4309