Healthcare Provider Details

I. General information

NPI: 1184615189
Provider Name (Legal Business Name): SHERRY L RYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W 74TH ST SUITE 269
SHAWNEE MISSION KS
66204-2204
US

IV. Provider business mailing address

8901 W 74TH ST SUITE 269
SHAWNEE MISSION KS
66204-2204
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-7585
  • Fax: 913-676-8189
Mailing address:
  • Phone: 913-676-7585
  • Fax: 913-676-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number103093
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-23008
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: