Individual
SHANNON MOIRA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
8700 MENCHACA RD STE 806, AUSTIN, TX 78748-5379
(254) 290-2183
Mailing address
400 W SAINT ELMO RD APT 1007, AUSTIN, TX 78745-3316
(254) 290-2183
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT86901
TX
Other
Enumeration date
06/15/2023
Last updated
06/15/2023
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