Provider Demographics
NPI:1689700882
Name:RYAN, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 STINCHFIELD HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04938-3025
Mailing Address - Country:US
Mailing Address - Phone:218-209-2702
Mailing Address - Fax:
Practice Address - Street 1:169 SOUTH RD
Practice Address - Street 2:
Practice Address - City:READFIELD
Practice Address - State:ME
Practice Address - Zip Code:04355-3340
Practice Address - Country:US
Practice Address - Phone:218-209-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist