Provider Demographics
NPI:1801493978
Name:SHEA, RYAN (AUD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 MONTGOMERY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1913
Mailing Address - Country:US
Mailing Address - Phone:610-667-3277
Mailing Address - Fax:610-667-1662
Practice Address - Street 1:916 MONTGOMERY AVENUE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1913
Practice Address - Country:US
Practice Address - Phone:610-667-3277
Practice Address - Fax:610-667-1662
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006718237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter