Provider Demographics
NPI:1245613736
Name:NIGHTINGALE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:NIGHTINGALE
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 1:8404 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2547
Mailing Address - Country:US
Mailing Address - Phone:716-298-8976
Mailing Address - Fax:716-298-1597
Practice Address - Street 1:8404 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2547
Practice Address - Country:US
Practice Address - Phone:716-298-8976
Practice Address - Fax:716-298-1597
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000044695237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist