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Shannon Allison Sullivan

Student in an Organized Health Care Education/Training Program

Student, Health Care

101 The City Drive S, City Tower, Ste 400, Orange, CA 92868

PECOS Enrollment

This provider is enrolled in PECOS as SHANNON SULLIVAN.

Based on the most recent information from CMS, provider Shannon Allison Sullivan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1730716010
Provider Type
Individual
Full Name
Sullivan, Shannon Allison
Gender
Female

Sole Proprietor
No
Enumeration Date
3/25/2020
Last Updated
1/14/2021

Contact Information

Practice Location

101 The City Drive S, City Tower, Ste 400, Orange, CA 92868

(714) 456-5691

(714) 456-8874

Mailing Location

101 The City Dr S Ste 400, Orange, CA 92868-3201

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Shannon Allison Sullivan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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