Individual
SHANNON SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
20 E EATON AVE, TRACY, CA 95376-3100
(209) 553-0737
Mailing address
20 E EATON AVE, TRACY, CA 95376-3100
(209) 553-0737
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
163W00000X
Registered Nurse
789456
IA
Other
Enumeration date
10/17/2018
Last updated
05/03/2025
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