Healthcare Provider Details

I. General information

NPI: 1659937985
Provider Name (Legal Business Name): RYAN NIGHTINGALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/17/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MARTIN ST
WELLSVILLE NY
14895-1057
US

IV. Provider business mailing address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-4250
  • Fax: 855-593-2465
Mailing address:
  • Phone: 585-593-1100
  • Fax: 585-596-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number315910
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number315910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: