Provider Demographics
NPI:1407824691
Name:RYAN, SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 HIGHWAY 516
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1746
Mailing Address - Country:US
Mailing Address - Phone:732-952-0626
Mailing Address - Fax:732-463-6071
Practice Address - Street 1:2107 HIGHWAY 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1746
Practice Address - Country:US
Practice Address - Phone:732-952-0626
Practice Address - Fax:732-463-6071
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05367400207QG0300X
NJMA53674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4561601Medicaid
NJ4561601Medicaid
681296Medicare PIN