Individual
RYAN CANEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2296
(631) 261-4400
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
755628
NY
175T00000X
Peer Specialist
NYCPS-P-225
NY
Other
Enumeration date
12/22/2015
Last updated
09/27/2019
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