Active NPI
Shannon Sullivan, MA CCC-SLP
- Speech-Language Pathologist
- Sturbridge, MA
National Provider Identifier
1114394202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5734
- Practice address
- 64 Main St
Sturbridge, MA 01566-1244 - Phone
- (774) 318-1900
- Fax
- (774) 272-8810
- NPI assigned
- Aug 25, 2015
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5734 | MA | Primary |
Addresses
Primary practice location
64 Main St
Sturbridge, MA 01566-1244
Mailing address
64 Main St
Sturbridge, MA 01566-1244
Phone (774) 318-1900
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5734 | MA | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South County Therapies LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Hearing and Speech Clinic/Center
- Southbridge, MA
- NPI 1912437633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1114394202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64 MAIN ST",
"city": "STURBRIDGE",
"state": "MA",
"postal_code": "015661244",
"telephone_number": "774-318-1900",
"fax_number": "774-272-8810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "64 MAIN ST",
"city": "STURBRIDGE",
"state": "MA",
"postal_code": "015661244",
"telephone_number": "774-318-1900",
"fax_number": "774-272-8810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SHANNON",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-25",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "5734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sturbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.