Individual
DR. SHELLEY OLIVIA SUTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2045 FAIRMONT DR, SAN LEANDRO, CA 94578-1088
(510) 667-7540
Mailing address
6316 EL PASO ST, WHITESTOWN, IN 46075-5503
(317) 847-8298
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
2003012262
MO
2084P0804X
Child & Adolescent Psychiatry Physician
4301093327
MI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
C53616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177466
BLUE CROSS BLUE SHIELD
MO
05
—
208800300
—
MO
Enumeration date
09/20/2006
Last updated
03/22/2022
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