Provider Demographics
NPI:1477388361
Name:AMADEUS, RYAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:AMADEUS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8802 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1038
Mailing Address - Country:US
Mailing Address - Phone:917-601-3478
Mailing Address - Fax:
Practice Address - Street 1:450 SAINT PAULS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1938
Practice Address - Country:US
Practice Address - Phone:718-681-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist