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Individual

DR. SHELBY A SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-0001
(603) 650-5000
Mailing address
PO BOX 810, HANOVER, NH 03755-0810

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
2007006900
MO
207RG0100X
Gastroenterology Physician
Primary
32061
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
968790183
MO
Enumeration date
05/03/2007
Last updated
05/13/2024
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