Provider Demographics
NPI:1811517618
Name:CASSIDY, RYAN MICHAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 23RD AVENUE SOUTH
Mailing Address - Street 2:TRAINING OFFICE, SUITE 3105 VPH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-8645
Mailing Address - Country:US
Mailing Address - Phone:615-322-7000
Mailing Address - Fax:
Practice Address - Street 1:5615 H MARK CROSSWELL JR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1080
Practice Address - Country:US
Practice Address - Phone:713-500-1500
Practice Address - Fax:713-500-2714
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN644232084P0800X
390200000X
TXU94882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program