Individual
SHELBY LYNNE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 746-2000
Mailing address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 746-2000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
118920
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118920
—
MA
Enumeration date
01/29/2018
Last updated
12/24/2018
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