Provider Demographics
NPI:1992789655
Name:RYAN, SEAN D (PA-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:RYAN
Suffix:
Gender:M
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 1:1500 LEE BLVD
Mailing Address - Street 2:LEHIGH REGIONAL MEDICAL CENTER
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4835
Mailing Address - Country:US
Mailing Address - Phone:239-369-2101
Mailing Address - Fax:239-368-4510
Practice Address - Street 1:1500 LEE BLVD
Practice Address - Street 2:LEHIGH REGIONAL MEDICAL CENTER
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4835
Practice Address - Country:US
Practice Address - Phone:239-369-2101
Practice Address - Fax:239-368-4510
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290503500Medicaid
S76194Medicare UPIN
FLE2276VMedicare ID - Type Unspecified
FL290503500Medicaid
FLE2276PMedicare PIN