Provider Demographics
NPI:1477988160
Name:SULLIVAN-SHELTON, SANDY FAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:FAYE
Last Name:SULLIVAN-SHELTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22536 N 2790 RD
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-7160
Mailing Address - Country:US
Mailing Address - Phone:405-699-2146
Mailing Address - Fax:
Practice Address - Street 1:22536 N 2790 RD
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-7160
Practice Address - Country:US
Practice Address - Phone:405-699-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor