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General NPI Number Information
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NPI Number | 1447992375
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Entity Type | Individual
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Provider Name | SHAUNA KAY SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 2838 N LOOP 1604 E
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1711
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Country | US
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Telephone | 210-591-2074
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Fax |
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Provider Business Mailing Address
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Address Line | 132 LACELEAF LN
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City | CIBOLO
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State | TX
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Zip | 78108-3153
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Country | US
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Telephone | 210-232-4756
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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