Provider Demographics
NPI:1740532837
Name:RYAN, MAURA ANN (MS SLP-CF)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LAKE SHORE RD APT 11A
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3166
Mailing Address - Country:US
Mailing Address - Phone:516-672-8343
Mailing Address - Fax:
Practice Address - Street 1:147 LAKE SHORE RD APT 11A
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3166
Practice Address - Country:US
Practice Address - Phone:516-672-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program