Sullivan, Shannon J

Sullivan, Shannon J is an individual health care provider with primary practice located at 200 Hawkins Dr , Iowa City IA 52242-1009. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Sullivan, Shannon J can be contacted via phone (319) 384-7745.

Contact Information

Primary practice address
200 Hawkins Dr Iowa City IA 52242-1009
Phone: (319) 384-7745
Fax: (319) 384-6295
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 33360 Iowa
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 33360 Iowa

Profile Details

NPI number 1093702755
LBN Legal business name Sullivan, Shannon J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 28th, 2005
Last updated Dec 18th, 2007 - about 17 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 1093702755 NPPES
Iowa Other 16241 WELLMARK BCBS
Iowa MEDICAID 0206524 WELLMARK BCBS

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