Provider Demographics
NPI:1750019378
Name:RYAN, HAILEY SUZANNE
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:SUZANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SWIFT ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5049
Mailing Address - Country:US
Mailing Address - Phone:315-704-8315
Mailing Address - Fax:
Practice Address - Street 1:739 STATE ROUTE 28
Practice Address - Street 2:SUITE 9
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1382
Practice Address - Country:US
Practice Address - Phone:607-431-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349732-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily