Provider Demographics
NPI:1467087973
Name:CALLISTE, RYAH BIANKA
Entity Type:Individual
Prefix:
First Name:RYAH
Middle Name:BIANKA
Last Name:CALLISTE
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 1:686 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3316
Mailing Address - Country:US
Mailing Address - Phone:347-533-1123
Mailing Address - Fax:
Practice Address - Street 1:686 E 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3316
Practice Address - Country:US
Practice Address - Phone:347-533-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist