Healthcare Provider Details

I. General information

NPI: 1831745447
Provider Name (Legal Business Name): SHANNON NICOLE CULLIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 11/27/2023
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S STATE ST
DOVER DE
19901-4112
US

IV. Provider business mailing address

2519 NICHOLBY DR
WILMINGTON DE
19808-4212
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7676
  • Fax:
Mailing address:
  • Phone: 302-373-3753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberL1-0039601
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001302
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001302
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: