Provider Demographics
NPI:1467904938
Name:SWILLEY, RYAN MATTHEW
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:SWILLEY
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 1:1206 OAK ST NE
Mailing Address - Street 2:9
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1246
Mailing Address - Country:US
Mailing Address - Phone:813-335-7990
Mailing Address - Fax:
Practice Address - Street 1:5029 16TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6034
Practice Address - Country:US
Practice Address - Phone:813-335-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst