MEDICARE: DR. RYAN ALAN SHIELDS MD

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	207W00000X	Ophthalmology Physician	ME148306	FL
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME148306	FL

General Provider Information

NPI Number	:	1255726618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ALAN SHIELDS MD

Provider Business Mailing Address
First Line	:	6333 N FEDERAL HWY STE 300
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1909
Country	:	US
Telephone Number	:	954-776-6880
Fax Number	:	954-776-6895

Provider Business Practice Location Address
First Line	:	6333 N FEDERAL HWY STE 300
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1909
Country	:	US
Telephone Number	:	954-776-6880
Fax Number	:	954-776-6895

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	06/04/2024

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