Healthcare Provider Details

I. General information

NPI: 1982262655
Provider Name (Legal Business Name): RYAN CHRISTOPHER STAIB DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

207 BRAMPTON RD
SYRACUSE NY
13205-2858
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-0033
  • Fax:
Mailing address:
  • Phone: 315-601-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number634666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: