Provider Demographics
NPI:1447807748
Name:SHEHANE, RYAN ALEXANDER
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALEXANDER
Last Name:SHEHANE
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 1:2925 WIGWAM PKWY APT 1224
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2874
Mailing Address - Country:US
Mailing Address - Phone:702-544-0830
Mailing Address - Fax:
Practice Address - Street 1:2925 WIGWAM PKWY APT 1224
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-2874
Practice Address - Country:US
Practice Address - Phone:702-544-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program