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NPI Code Detail

MEDICARE: SHAKEIRA SULLIVAN

MEDICARE: SHAKEIRA SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician106S00000XNJ

General Provider Information

NPI Number : 1023963196
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAKEIRA SULLIVAN
Provider Business Mailing Address
First Line : 1334 DREXEL AVE
Second Line :
City : ATLANTIC CITY
State : NJ
Zip : 08401-3203
Country : US
Telephone Number : 619-373-5034
Fax Number :
Provider Business Practice Location Address
First Line : 407 GLENN AVE
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-6109
Country : US
Telephone Number : 877-504-4141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ SHAKEIRA SULLIVAN ” Practice Location

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