MEDICARE: SHELBY RYAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904008624	VA

General Provider Information

NPI Number	:	1083021182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY RYAN LCSW

Provider Business Mailing Address
First Line	:	1815 ARDEN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-2701
Country	:	US
Telephone Number	:	540-793-4361
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 BRANDON AVE SW
Second Line	:	SUITE 100
City	:	ROANOKE
State	:	VA
Zip	:	24018-1516
Country	:	US
Telephone Number	:	540-777-3935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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