Healthcare Provider Details

I. General information

NPI: 1467090589
Provider Name (Legal Business Name): SEAN JAMES RYAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLOCK TOWER CMNS
BREWSTER NY
10509-4055
US

IV. Provider business mailing address

11 ASPEN RD
HOPEWELL JUNCTION NY
12533-6234
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5187
  • Fax: 855-703-7570
Mailing address:
  • Phone: 914-618-0907
  • Fax: 855-703-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number724561
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: