Provider Demographics
NPI:1770253247
Name:STAUDLE, RYAN DANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANIEL
Last Name:STAUDLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1104
Mailing Address - Country:US
Mailing Address - Phone:845-325-9880
Mailing Address - Fax:
Practice Address - Street 1:270 LANCASTER AVE BLDG J
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1858
Practice Address - Country:US
Practice Address - Phone:484-228-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical