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Individual
KELLEN RYAN
Active
Individual
KELLEN RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
032029
NY
363AM0700X
Medical Physician Assistant
032029
NY
363AS0400X
Surgical Physician Assistant
032029
NY
Other
Enumeration date
10/30/2024
Last updated
11/11/2024
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