Healthcare Provider Details

I. General information

NPI: 1033893672
Provider Name (Legal Business Name): ALEXANDRA RYDER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA KARLEWICZ

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WILDWOOD RD
COLONIAL BEACH VA
22443-3518
US

IV. Provider business mailing address

34 WILDWOOD RD
COLONIAL BEACH VA
22443-3518
US

V. Phone/Fax

Practice location:
  • Phone: 518-944-3447
  • Fax:
Mailing address:
  • Phone: 518-944-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number009944
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberDX6144
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: