Individual
RYAN WAYNE SEIDL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
468 OLD CHEROKEE RD, LEXINGTON, SC 29072-9031
(803) 970-6972
(839) 218-5344
Mailing address
AGE WELL LLC, 468 OLD CHEROKEE ROAD, LEXINGTON, SC 29072
(803) 970-6972
(839) 218-5344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2852
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3540PA
—
SC
Enumeration date
02/22/2018
Last updated
05/14/2025
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