Sullivan, Shane

Sullivan, Shane is an individual health care provider with primary practice located at 10133 N 92Nd St Ste 101 , Scottsdale AZ 85258-4556. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Sullivan, Shane can be contacted via phone (480) 584-3334.

Contact Information

Primary practice address
10133 N 92Nd St Ste 101 Scottsdale AZ 85258-4556
Phone: (480) 584-3334
Fax: (480) 272-9369
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 6673 Arizona
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports 2251S0007X 6673 Arizona

Profile Details

NPI number 1942371216
LBN Legal business name Sullivan, Shane
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2006
Last updated Feb 18th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942371216 NPPES
Arizona MEDICAID 290315

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