Provider Demographics
NPI:1093334823
Name:SEIAVITCH, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SEIAVITCH
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 1:725 HARBOUR POST DR APT 2405
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-6759
Mailing Address - Country:US
Mailing Address - Phone:412-508-9075
Mailing Address - Fax:
Practice Address - Street 1:2685 ULMERTON RD STE 103
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3332
Practice Address - Country:US
Practice Address - Phone:727-572-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN26223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program