Healthcare Provider Details

I. General information

NPI: 1538659073
Provider Name (Legal Business Name): RYAN DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N MAIN ST STE 60
DAYTON OH
45415-2558
US

IV. Provider business mailing address

9145 N DIXIE DR
DAYTON OH
45414-1859
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-9500
  • Fax: 855-482-2337
Mailing address:
  • Phone: 937-426-9500
  • Fax: 855-482-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number59.000725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: