Active NPI
Shantel Nicole Sullivan, LMSW
- Social Worker
- Potsdam, NY
National Provider Identifier
1104166644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0771741
- Practice address
- 50 Leroy St
Potsdam, NY 13676-1786 - Phone
- (315) 261-5411
- NPI assigned
- Feb 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 0771741 | NY | Primary |
Addresses
Primary practice location
50 Leroy St
Potsdam, NY 13676-1786
Mailing address
7 School St
Massena, NY 13662-1713
Phone (315) 353-2572
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0771741 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361318400000",
"number": "1104166644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 SCHOOL ST",
"city": "MASSENA",
"state": "NY",
"postal_code": "136621713",
"telephone_number": "315-353-2572",
"fax_number": "315-353-2479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 LEROY ST",
"city": "POTSDAM",
"state": "NY",
"postal_code": "136761786",
"telephone_number": "315-261-5411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SHANTEL",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-20",
"last_updated": "2013-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "0771741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potsdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.