Healthcare Provider Details

I. General information

NPI: 1437330503
Provider Name (Legal Business Name): CLAUDETTE MINTO RYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VALLEY FORGE DR
WHEATLEY HEIGHTS NY
11798-1215
US

IV. Provider business mailing address

8 VALLEY FORGE DR
WHEATLEY HEIGHTS NY
11798-1215
US

V. Phone/Fax

Practice location:
  • Phone: 646-522-3502
  • Fax: 631-920-0976
Mailing address:
  • Phone: 646-522-3502
  • Fax: 631-920-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: