1033181490 NPI number — DR. SHAUNA FRANCES O'SULLIVAN D.O

Table of content: DR. SHAUNA FRANCES O'SULLIVAN D.O (NPI 1033181490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033181490 NPI number — DR. SHAUNA FRANCES O'SULLIVAN D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'SULLIVAN
Provider First Name:
SHAUNA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033181490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NAS JACKSONVILLE
Provider Second Line Business Mailing Address:
BUILDING 554
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-953-7550
Provider Business Mailing Address Fax Number:
757-953-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 BOB WILSON DR
Provider Second Line Business Practice Location Address:
NMCSD SUITE 300
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92134-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-532-5200
Provider Business Practice Location Address Fax Number:
619-532-7508
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  02002814A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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