Provider Demographics
NPI:1376249771
Name:SHEA, RYAN (RN)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WELLER AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3318
Mailing Address - Country:US
Mailing Address - Phone:716-341-6420
Mailing Address - Fax:
Practice Address - Street 1:333 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5369
Practice Address - Country:US
Practice Address - Phone:413-499-0412
Practice Address - Fax:413-499-0995
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2343086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163W00000XNursing Service ProvidersRegistered Nurse