Shannon Sullivan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP02415 Issued in PA

Practice address

1555 Schuylkill Ave
Reading, PA 19601-1312

Phone

(610) 378-0107

NPI assigned

Mar 12, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ssullivan@berksgenesisfm.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Joseph Medical Group

  • Family Medicine Physician
  • Reading, PA
  • NPI 1184754657
  NPD
• St. Joseph Medical Group

  • Anesthesiology Physician
  • Reading, PA
  • NPI 1841680881
  NPD

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1811755044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2062 GRACE AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170468025",
            "telephone_number": "412-584-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SCHUYLKILL AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196011312",
            "telephone_number": "610-378-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP02415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Ann Stufflet, LCSW
• Virginia Stufflet, RN
• Jose Sigfredo Subervi, M.D.
• Kim A Sullivan, MA, LPC
• Lindsey Kayla Sullivan, OTR/L
• Daniel S Sullum, MD
• Kilah Summers
• Summit Chiropractic and Rehabilitation PC
• Carol Ruth Sunanday
• Sunshine Pediatric Day Center, Reading, LLC

• Family Nurse Practitioner in Reading, PA
• Providers in Reading, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.