Healthcare Provider Details

I. General information

NPI: 1336117555
Provider Name (Legal Business Name): DANIEL M RYAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 BENSON DR
RALEIGH NC
27609-7321
US

IV. Provider business mailing address

3710 BENSON DR
RALEIGH NC
27609-7321
US

V. Phone/Fax

Practice location:
  • Phone: 919-878-7800
  • Fax: 919-878-9983
Mailing address:
  • Phone: 919-878-7800
  • Fax: 919-878-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: