Shannon Sullivan

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

7401002983 Issued in MI

Practice address

26210 Harper Ave
Saint Clair Shores, MI 48081-2203

Phone

(734) 796-6612

NPI assigned

Jul 21, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lumen Pediatric Therapy, LLC

  • Behavior Analyst
  • Saint Clair Shores, MI
  • NPI 1093445900
  NPD (past)
• Lumen Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Saint Clair Shores, MI
  • NPI 1407573942

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1487536611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26210 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812203",
            "telephone_number": "734-796-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26210 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812203",
            "telephone_number": "734-796-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-21",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401002983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Stromont
• Stuart Leff DPM, P.C.
• Stephen A Stuppler, M.D.
• Andrew J Sulich, MD
• Miranda Elizabeth Sullivan
• Karen L. Summe, MD
• Matthew Surducan
• Surgical Specialist of Michigan PC
• Susan a. Radtke, M.D., P.C.
• Susan Boyd, LLP PC

• Behavior Analyst in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.

Verify at the official NPI Registry.