Provider Demographics
NPI:1316915127
Name:RYAN, SHAWNIA RAE (MS, CGC)
Entity type:Individual
Prefix:
First Name:SHAWNIA
Middle Name:RAE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:SHAWNIA
Other - Middle Name:RAE
Other - Last Name:FORRESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1001 TRAMWAY BLVD NE
Mailing Address - Street 2:#33
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6280
Mailing Address - Country:US
Mailing Address - Phone:505-925-0156
Mailing Address - Fax:505-925-0187
Practice Address - Street 1:1201 CAMINO DE SALUD
Practice Address - Street 2:MSC07 4025
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-0156
Practice Address - Fax:505-925-0187
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
NMGC2014-011170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS