Provider Demographics
NPI:1902524705
Name:ANGELO, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ANGELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 BRAEMAR CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8293
Mailing Address - Country:US
Mailing Address - Phone:801-726-0617
Mailing Address - Fax:
Practice Address - Street 1:905 BRAEMAR CIR
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8293
Practice Address - Country:US
Practice Address - Phone:801-726-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500346Medicaid