Provider Demographics
NPI:1295069383
Name:RYAN, MARY SHANNON (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY SHANNON
Middle Name:
Last Name:RYAN
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 1:350 SOMBRERO BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3946
Mailing Address - Country:US
Mailing Address - Phone:305-289-2480
Mailing Address - Fax:305-289-2486
Practice Address - Street 1:350 SOMBRERO BEACH RD
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3946
Practice Address - Country:US
Practice Address - Phone:305-289-2480
Practice Address - Fax:305-289-2486
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9294067163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool