Healthcare Provider Details

I. General information

NPI: 1871151753
Provider Name (Legal Business Name): RYAN SATTAR DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PLAZA CIR STE N
CLINTON SC
29325-7556
US

IV. Provider business mailing address

700 PLAZA CIR STE N
CLINTON SC
29325-7556
US

V. Phone/Fax

Practice location:
  • Phone: 864-547-2160
  • Fax: 864-547-2159
Mailing address:
  • Phone: 706-503-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number216987
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22986
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: