Provider Demographics
NPI:1457239055
Name:ANDERSON, RYAN ROBERT
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ROBERT
Last Name:ANDERSON
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 1:134 OLD CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2072
Mailing Address - Country:US
Mailing Address - Phone:570-899-2237
Mailing Address - Fax:
Practice Address - Street 1:2 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4210
Practice Address - Country:US
Practice Address - Phone:203-702-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant