Provider Demographics
NPI:1487262846
Name:SULLIVAN, SHARON MARIE (RN, LPS)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN, LPS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:133 W CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1109
Mailing Address - Country:US
Mailing Address - Phone:626-230-6191
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician