Individual
SHANE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4221 GARRETT RD, DURHAM, NC 27707-3467
(919) 937-9607
Mailing address
1611 CHESBOROUGH RD, WINSTON SALEM, NC 27127-7317
(336) 409-6320
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
P21873
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
01/18/2023
Last updated
01/18/2023
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