Provider Demographics
NPI:1720518202
Name:SHERICK, RYAN MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MARK
Last Name:SHERICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JENSEN CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7484
Mailing Address - Country:US
Mailing Address - Phone:805-904-0476
Mailing Address - Fax:
Practice Address - Street 1:110 JENSEN CT STE 1B
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7484
Practice Address - Country:US
Practice Address - Phone:805-904-0476
Practice Address - Fax:805-436-3097
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5646213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program