Basic Information
| Provider Information | |||||||||
| NPI: | 1316924384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 783 DOCTORS CT STE C | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275734575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365979200 | ||||||||
| FaxNumber: | 3365979202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2609 N DUKE ST | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277043048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192202020 | ||||||||
| FaxNumber: | 9192209257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 12/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 9701862 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 891086P | 05 | NC | MEDICAID | ENT32 | 01 | NC | PRIMA | OTHER | 1086P | 01 | NC | BCBS | OTHER | 8436056 | 01 | NC | CIGNA | OTHER | 1000373 | 01 | NC | UHC | OTHER |