Provider Demographics
NPI:1609593458
Name:RYAN, ANGELA PEARL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PEARL
Last Name:RYAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RYARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3416
Mailing Address - Country:US
Mailing Address - Phone:904-206-7701
Mailing Address - Fax:
Practice Address - Street 1:43 RYARBOR DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-3416
Practice Address - Country:US
Practice Address - Phone:904-206-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical