Provider Demographics
NPI:1013555796
Name:ESTELLE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ESTELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 170
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4549
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:844-959-0418
Practice Address - Street 1:900 VILLAGE SQUARE XING STE 170
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4549
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:844-959-0418
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant