Provider Demographics
NPI:1699027987
Name:RYAN, DANIELLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:165 N 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2954
Mailing Address - Country:US
Mailing Address - Phone:904-477-3807
Mailing Address - Fax:
Practice Address - Street 1:1474 GRACE LAKE CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-2835
Practice Address - Country:US
Practice Address - Phone:407-852-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist