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General NPI Number Information
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NPI Number | 1962781948
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Entity Type | Organization
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Legal Business Name | SHAWN M SULLIVAN DO PC
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3295 N DRINKWATER BLVD STE 5
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6437
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Country | US
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Telephone | 480-949-0298
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Fax | 480-949-1258
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Provider Business Mailing Address
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Address Line | 3295 N DRINKWATER BLVD STE 5
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6437
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Country | US
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Telephone | 480-949-0298
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Fax | 480-949-1258
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SHAWN MICHAEL SULLIVAN
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Credential | D.O.
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Telephone | 480-949-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3270
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License Number State | AZ
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