Healthcare Provider Details

I. General information

NPI: 1629782123
Provider Name (Legal Business Name): RYAN STEVEN CAULFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA ST
PITTSBURGH PA
15213-2543
US

IV. Provider business mailing address

2521C SIDNEY ST
PITTSBURGH PA
15203-2198
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-4586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN743333
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: