Healthcare Provider Details

I. General information

NPI: 1992645857
Provider Name (Legal Business Name): TONYA RIDGWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 JAMES ST
SYRACUSE NY
13203-2238
US

IV. Provider business mailing address

518 JAMES ST
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-5506
  • Fax: 315-474-5506
Mailing address:
  • Phone: 315-474-5506
  • Fax: 315-474-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: