Shannon Ryan | San Diego, CA • PECOS Search

Shannon Ryan

Behavior Technician

Behavioral Health & Social Service Providers

3878 Ruffin Rd, Unit B, San Diego, CA 92123

(619) 795-9925 (914) 357-6708

PECOS Enrollment

Based on the most recent information from CMS, provider Shannon Ryan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1033996244
Provider Type
Individual
Full Name
Ryan, Shannon
Gender
Female

Sole Proprietor
No
Enumeration Date
9/11/2023
Last Updated
9/11/2023

Contact Information

Practice Location

3878 Ruffin Rd, Unit B, San Diego, CA 92123

Unlisted Fax

Mailing Location

3244 Idlewild Way, San Diego, CA 92117-3506

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License Unlisted Issuer