Provider Demographics
NPI:1972544450
Name:SULLIVAN, SHAWN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3295 N DRINKWATER BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6437
Mailing Address - Country:US
Mailing Address - Phone:480-949-0298
Mailing Address - Fax:480-949-1258
Practice Address - Street 1:3295 N DRINKWATER BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6437
Practice Address - Country:US
Practice Address - Phone:480-949-0298
Practice Address - Fax:480-949-1258
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ26475Medicare UPIN
AZZ26475Medicare UPIN