Healthcare Provider Details

I. General information

NPI: 1396277125
Provider Name (Legal Business Name): RYAN CEPHAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 GEORGIA AVE STE 170
SILVER SPRING MD
20910-4959
US

IV. Provider business mailing address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-4787
  • Fax: 202-360-4787
Mailing address:
  • Phone: 801-581-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0103743
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0103743
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: