Individual
DR. SHANNON MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2005 MIDWAY RD, MENASHA, WI 54952
(920) 832-8500
(920) 993-2919
Mailing address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 996-3264
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66251
WI
Other
Enumeration date
03/31/2015
Last updated
09/13/2018
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