MEDICARE: DOMINIQUE SHUNTA SULTON

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
1	251J00000X	Nursing Care Agency	60561	MS

General Provider Information

NPI Number	:	1366211138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE SHUNTA SULTON

Provider Business Mailing Address
First Line	:	5600 KEELE ST APT 1808
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-2047
Country	:	US
Telephone Number	:	251-550-7748
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 KEELE ST APT 1808
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-2047
Country	:	US
Telephone Number	:	251-550-7748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/21/2023

Similar Medicare Providers

1669479234 — MS. SUZANNE BENTLEY KIRK BS, MS, FNP
Practice Location Address:

1198 N WEST AVE
JACKSON, MI
49202-2047

Practice Phone: 517-789-1200
Practice Fax: 517-796-4547

1245652577 — HILLCREST FAMILY SERVICES
Practice Location Address:

106 N JACKSON ST
MT PLEASANT, IA
52641-2047

Practice Phone: 319-385-7177
Practice Fax: 319-385-9567

1750784724 — ELLA HEPHZIBAH
Practice Location Address:

1190 N WEST AVE STE 812
JACKSON, MI
49202-2047

Practice Phone: 517-513-3657
Practice Fax: 517-513-3693

1780042341 — HEATHER LUJANO LMSW
Practice Location Address:

106 N JACKSON ST
MT PLEASANT, IA
52641-2047

Practice Phone: 319-385-7177
Practice Fax: 319-385-9567

1760831986 — NIKOL OLSON
Practice Location Address:

9040 JACKSON AVE
TACOMA, WA
98431-2047

Practice Phone: 253-477-6365
Practice Fax:

1639692270 — KELSEY EDWARDS
Practice Location Address:

106 N JACKSON ST
MT PLEASANT, IA
52641-2047

Practice Phone: 319-385-7177
Practice Fax: 319-385-9567

Directions to “ DOMINIQUE SHUNTA SULTON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.