Provider Demographics
NPI:1780636258
Name:RYAN, VICTORIA YOUNG (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:YOUNG
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 WOOSTER LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3223
Mailing Address - Country:US
Mailing Address - Phone:239-472-6877
Mailing Address - Fax:239-472-6870
Practice Address - Street 1:2323 WOOSTER LN
Practice Address - Street 2:SUITE 1
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3223
Practice Address - Country:US
Practice Address - Phone:239-472-6877
Practice Address - Fax:239-472-6870
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL005618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54380OtherBC/BS
FLE0128Medicare ID - Type Unspecified