Active NPI
Shea Sullins
- Pharmacist
- Portland, TN
National Provider Identifier
1851905079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0000038336
- Practice address
- 104 Highway 52 W
Portland, TN 37148-1406 - Phone
- (615) 325-4058
- NPI assigned
- Sep 4, 2020
- Last updated
- Sep 4, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0000038336 | TN | Primary |
Addresses
Primary practice location
104 Highway 52 W
Portland, TN 37148-1406
Mailing address
104 Highway 52 W
Portland, TN 37148-1406
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000038336 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients |
Locations
104 Highway 52 W
Portland, TN 37148
Phone (615) 325-4058
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599177600000",
"number": "1851905079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 HIGHWAY 52 W",
"city": "PORTLAND",
"state": "TN",
"postal_code": "371481406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 HIGHWAY 52 W",
"city": "PORTLAND",
"state": "TN",
"postal_code": "371481406",
"telephone_number": "615-325-4058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLINS",
"first_name": "SHEA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-04",
"last_updated": "2020-09-04",
"certification_date": "2020-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "0000038336",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TN
- Southern Sports Medicine Portland
- Spine Stop Portland, PLLC
- State of Tennessee (Sumner County Portland Clinic)
- Michael E Stinnett, RPH
- Dawn Michelle Stinson, PTA
- Sumner Physician Practices LLC (Portland Family Wellness)
- Sumner Physician Practices LLC (Weatherstone Family Wellness)
- Lori Swindle
- SWS Services, Inc
- John A Taylor, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.