Individual
SHAWN A SUTTERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004367
VA
363A00000X
Physician Assistant
PA0000001123
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517435
—
TN
05
—
1891750097
—
VA
05
—
3662175
—
TN
Enumeration date
04/19/2006
Last updated
12/17/2019
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