IndividualActive
Shane Sullivan
NPI 1184339699 · Sports Medicine (Physical Medicine & Rehabilitation) Physician · Durham, NC
Provider details
- NPI number
- 1184339699
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- Yes
- License
- P21873 (NC)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
4221 Garrett Rd
Durham, NC 27707-3467
Phone: (919) 937-9607
Approximate (ZIP-level) locationGet directions
Mailing address
1611 Chesborough Rd
Winston Salem, NC 27127-7317
Registry dates
- Enumerated
- 2023-01-18
- Last updated
- 2023-01-18
- Certified
- 2023-01-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.