Healthcare Provider Details

I. General information

NPI: 1922544923
Provider Name (Legal Business Name): RYAN SHOLINSKY CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 EASTON RD
WILLOW GROVE PA
19090-1901
US

IV. Provider business mailing address

1201 LATONA ST
PHILADELPHIA PA
19147-4505
US

V. Phone/Fax

Practice location:
  • Phone: 215-830-5400
  • Fax:
Mailing address:
  • Phone: 732-213-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP016837
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: