Healthcare Provider Details

I. General information

NPI: 1699500249
Provider Name (Legal Business Name): SHAUNTA SULTON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 GARDEN ROSE CT
GREER SC
29651-6911
US

IV. Provider business mailing address

614 GARDEN ROSE CT
GREER SC
29651-6911
US

V. Phone/Fax

Practice location:
  • Phone: 678-334-1603
  • Fax:
Mailing address:
  • Phone: 678-334-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number269592
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: