Provider Demographics
NPI:1164445235
Name:SULLIVAN, SHAUN PAUL (MD)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:PAUL
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1880
Mailing Address - Country:US
Mailing Address - Phone:360-647-3377
Mailing Address - Fax:360-752-3214
Practice Address - Street 1:2980 SQUALICUM PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1880
Practice Address - Country:US
Practice Address - Phone:360-647-3377
Practice Address - Fax:360-752-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50039407OtherMEDICARE RR
WA8601809Medicaid
WA50039407OtherMEDICARE RR