Healthcare Provider Details

I. General information

NPI: 1982233086
Provider Name (Legal Business Name): RYAN MICHAEL SHANER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2378 SUNSET POINT RD
CLEARWATER FL
33765-1430
US

IV. Provider business mailing address

2378 SUNSET POINT RD
CLEARWATER FL
33765-1430
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-5007
  • Fax: 727-725-9737
Mailing address:
  • Phone: 727-797-5007
  • Fax: 727-725-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO04748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: