Healthcare Provider Details

I. General information

NPI: 1003307455
Provider Name (Legal Business Name): RYAN SADINSKI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3198
  • Fax:
Mailing address:
  • Phone: 757-388-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110006240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: