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General NPI Number Information
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NPI Number | 1023840717
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Entity Type | Individual
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Provider Name | SHAMECKA SULLIVAN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1000 NEIGHBORHOOD PL
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City | FAIRDALE
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State | KY
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Zip | 40118-9697
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Country | US
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Telephone | 502-361-2381
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Fax | 502-996-8309
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Provider Business Mailing Address
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Address Line | PO BOX 392552
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City | PITTSBURGH
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State | PA
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Zip | 15251-9500
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Country | US
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Telephone | 512-792-4402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4024554
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License Number State | KY
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