Healthcare Provider Details

I. General information

NPI: 1578086088
Provider Name (Legal Business Name): KARILYN RYDER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5267 PEARL RD
CLEVELAND OH
44129-1550
US

IV. Provider business mailing address

3659 GREEN RD STE 106
BEACHWOOD OH
44122-5715
US

V. Phone/Fax

Practice location:
  • Phone: 216-485-5767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: