Provider Demographics
NPI:1376707950
Name:ULLAH, DANIEL RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RYAN
Last Name:ULLAH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 306
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2308
Mailing Address - Country:US
Mailing Address - Phone:407-932-6190
Mailing Address - Fax:407-932-6191
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 306
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2308
Practice Address - Country:US
Practice Address - Phone:407-932-6190
Practice Address - Fax:407-932-6191
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012573363A00000X
NJ25MP00197500363A00000X
FLPA9108694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant