Healthcare Provider Details

I. General information

NPI: 1790266658
Provider Name (Legal Business Name): RYAN SHICKMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 POWER INN RD STE 140
SACRAMENTO CA
95826-3889
US

IV. Provider business mailing address

3331 POWER INN RD STE 140
SACRAMENTO CA
95826-3889
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1183
  • Fax:
Mailing address:
  • Phone: 916-875-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY35108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: