Individual
SHANTI RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3822 SE POWELL BLVD, PORTLAND, OR 97202-1720
(888) 227-3312
(503) 717-9966
Mailing address
3915 E CAMELBACK RD, PHOENIX, AZ 85018-2633
(928) 533-8513
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1234509
CERTIFICATION
WA
01
—
PA70046563
LICENSE
WA
Enumeration date
12/06/2024
Last updated
11/04/2025
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