Basic Information
| Provider Information | |||||||||
| NPI: | 1740875053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIARELLO | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15280 NW 79TH CT STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055583724 | ||||||||
| FaxNumber: | 7869074485 | ||||||||
| Practice Location | |||||||||
| Address1: | 4302 ALTON RD STE 830 | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742950 | ||||||||
| FaxNumber: | 3056742749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2021 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9114117 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.