Provider Demographics
NPI:1427657055
Name:RYALL, ALYSON (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:RYALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 VENTURA PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4262
Mailing Address - Country:US
Mailing Address - Phone:772-532-9055
Mailing Address - Fax:
Practice Address - Street 1:3770 7TH TER STE 101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6553
Practice Address - Country:US
Practice Address - Phone:772-567-6602
Practice Address - Fax:772-567-7754
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1160693363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical