Provider Demographics
NPI:1902919731
Name:CALDEIRO, RYAN M (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:CALDEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 NACHES AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2627
Mailing Address - Country:US
Mailing Address - Phone:206-630-1305
Mailing Address - Fax:206-630-1301
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:C212, BOX 356340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6340
Practice Address - Country:US
Practice Address - Phone:206-543-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000471312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry