Healthcare Provider Details

I. General information

NPI: 1619149119
Provider Name (Legal Business Name): RYAN C. SHELSTAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N 103RD PLZ STE 200
OMAHA NE
68114-1119
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-0400
  • Fax: 402-354-0425
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number29323
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: