Active NPI
Shane Sullivan
- Physical Therapist
- Elon, NC
National Provider Identifier
1184339699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P21873
- Practice address
- 505 Blakey Hall LN
Elon, NC 27244-7966 - Phone
- (336) 260-2361
- NPI assigned
- Jan 18, 2023
- Last updated
- Aug 19, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | P21873 | NC | |
| Physical Therapist | 225100000X | P21873 | NC | Primary |
Addresses
Primary practice location
505 Blakey Hall LN
Elon, NC 27244-7966
Mailing address
1159 Pate Farm LN
Durham, NC 27703-6813
Phone (336) 409-6320
Other practice location 1
4221 Garrett Rd
Durham, NC 27707-3467
Phone (919) 937-9607
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ssullivan@uprightathlete.com |
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 |
|---|---|---|---|
| P21873 | NC | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787097600000",
"number": "1184339699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1159 PATE FARM LN",
"city": "DURHAM",
"state": "NC",
"postal_code": "277036813",
"telephone_number": "336-409-6320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 BLAKEY HALL LN",
"city": "ELON",
"state": "NC",
"postal_code": "272447966",
"telephone_number": "336-260-2361"
}
],
"practiceLocations": [
{
"address_1": "4221 Garrett Rd",
"address_purpose": "LOCATION",
"city": "Durham",
"state": "NC",
"postal_code": "277073467",
"country_code": "US",
"telephone_number": "919-937-9607",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-18",
"last_updated": "2026-08-19",
"certification_date": "2026-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "NC",
"license": "P21873",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P21873",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ssullivan@uprightathlete.com",
"affiliation": "N",
"address_1": "4221 Garrett Rd",
"city": "Durham",
"state": "NC",
"country_code": "US",
"postal_code": "277073467",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Elon, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.