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1184339699
SHANE SULLIVAN
DURHAM, NC
NPI
1184339699
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: NC P21873)
Enumeration Date
2023-01-18
Last Update Date
2023-01-18
Business Address
SHANE SULLIVAN
4221 GARRETT RD
DURHAM, NC 27707-3467
Phone number: 919-937-9607
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Mailing Address
SHANE SULLIVAN
1611 CHESBOROUGH RD
WINSTON SALEM, NC 27127-7317
Phone number: 336-409-6320
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