Provider Demographics
NPI:1063730125
Name:SHEA, RYAN CATHERINE (RN)
Entity type:Individual
Prefix:MISS
First Name:RYAN
Middle Name:CATHERINE
Last Name:SHEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PONDVIEW DR APT 28
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-6849
Mailing Address - Country:US
Mailing Address - Phone:631-278-7565
Mailing Address - Fax:
Practice Address - Street 1:9 PONDVIEW DR APT 28
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-6849
Practice Address - Country:US
Practice Address - Phone:631-278-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse