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RYAN SHACKELFORD, MD, PLLC

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Company Details

Name: RYAN SHACKELFORD, MD, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 26 Apr 2017 (8 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 551511
Place of Formation: IDAHO
File Number: 551511
ZIP code: 83702
County: Ada County
Principal Address: 1015 W HAYS ST #209 BOISE, ID 83702
Mailing Address: 1525 S OWYHEE ST BOISE, ID 83705-6014

Agent

Name Role Address
JAMES RYAN SHACKELFORD Agent 1525 S. OWYHEE STREET, RYAN SHACKELFORD, BOISE, ID 83705

Manager

Name Role Address Appointed On
Rhiana S Menen Manager 1525 S. OWYHEE STREET, BOISE, ID 83705 2021-03-03

Member

Name Role Address Appointed On
JAMES RYAN SHACKELFORD Member 1601 W GARFIELD ST, BOISE, ID 83705 2024-03-04

National Provider Identifier

NPI Number:
1447969506
Certification Date:
2022-11-17

Authorized Person:

Name:
JAMES RYAN SHACKELFORD
Role:
PSYCHIATRIST
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
2085618051

Filing

Filing Name Filing Number Filing date
Annual Report 0006143204 2025-03-05
Annual Report 0005629822 2024-03-04
Annual Report 0005230973 2023-05-06
Annual Report 0004635375 2022-03-05
Annual Report 0004191304 2021-03-03

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Date of last update: 14 May 2025

Sources: Idaho Secretary of State