Thelisa Y Sulton

Primary specialty

Technician/TechnologistTaxonomy code 156F00000X

License

2018-46169-45207 Issued in SC

Practice address

201 Columbia Mall Blvd Ste 189
Columbia, SC 29223-7550

Phone

(803) 602-5570

Fax

(888) 958-0279

NPI assigned

Apr 14, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Thelisa Sulton Other name

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• KTP Wellness Solution LLC

  dba Bio-Worx Wellness Therapy

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1346888948
  NPD Authorized official
• T&S Wellness LLC

  • Clinic/Center
  • Columbia, SC
  • NPI 1912554353
  NPD Authorized official
• Fajas of Columbia LLC

  • Other Specialist/Technologist
  • Columbia, SC
  • NPI 1659943140
  NPD

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

{
    "created_epoch": "1523664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580601600000",
    "number": "1851888978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 COLUMBIA MALL BLVD STE 189",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292237550",
            "telephone_number": "803-602-5570",
            "fax_number": "888-958-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 COLUMBIA MALL BLVD STE 189",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292237550",
            "telephone_number": "803-602-5570",
            "fax_number": "888-958-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULTON",
        "first_name": "THELISA",
        "middle_name": "Y",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-14",
        "last_updated": "2020-02-02",
        "certification_date": "2020-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "SC",
            "license": "2018-46169-45207",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "SC",
            "license": "2018-46169-45207",
            "primary": false
        },
        {
            "code": "156F00000X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist",
            "state": "SC",
            "license": "2018-46169-45207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THELISA",
            "last_name": "SULTON",
            "prefix": "MRS.",
            "credential": "MEDICAL ASSISTANT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kayleigh Sullivan, RBT
• Mary Ellen Sullivan, GNP-BC
• Meagan Sullivan
• Stylacia Denise Sullivan
• William Joseph Sullivan, PHYSICAL THERAPIST
• Lauren Nicole Summerell, DO
• Channell Summers, M.A., CCC-SLP
• Devonda Jan'Et Summers, RBT
• John Summers, D.D.S.
• Summit Sage Group Inc (Scalp & Strand Wellness Studio)

• Technician/Technologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Technician/Technologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2020; 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.