Provider Demographics
NPI:1295760254
Name:RYDEN, SALLY ELAINE (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ELAINE
Last Name:RYDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147050
Mailing Address - Street 2:PMB 509
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-7050
Mailing Address - Country:US
Mailing Address - Phone:352-375-0166
Mailing Address - Fax:352-375-1677
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4309
Practice Address - Country:US
Practice Address - Phone:352-333-3495
Practice Address - Fax:352-333-4284
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29117207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38333Medicare ID - Type UnspecifiedGROUP
FLE98179Medicare UPIN