Individual
RYLAN CICCARELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
455 W WARREN AVE, LONGWOOD, FL 32750-4038
(407) 262-2220
(407) 834-5011
Mailing address
455 W WARREN AVE, LONGWOOD, FL 32750-4038
(407) 262-2220
(407) 834-5011
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME169521
FL
2084P0800X
Psychiatry Physician
TRN30221
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123252500
—
FL
Enumeration date
03/26/2020
Last updated
08/06/2024
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