Provider Demographics
NPI:1205955697
Name:RYAN, SANDRA E (LIC AC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:RYAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2722
Mailing Address - Country:US
Mailing Address - Phone:617-461-0062
Mailing Address - Fax:
Practice Address - Street 1:544 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2722
Practice Address - Country:US
Practice Address - Phone:617-461-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist