Individual
SHAINA MARIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12370 SW 1ST ST, BEAVERTON, OR 97005-2847
(503) 644-3614
Mailing address
10095 NW CURTIS ST, NORTH PLAINS, OR 97133-8201
(971) 227-3630
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4434ATI
OR
Other
Enumeration date
02/04/2019
Last updated
07/19/2019
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