Most Relevant Information
Provider Data
| NPI Number: | 1003565441 |
| Provider Name: | SHIVON SULLIVAN |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/22/2022 |
| Last Updated: | 03/22/2022 |
Provider Practice Location
4849 LONE TREE WAY
SUITE C
ANTIOCH
CA
945318644
Practice Location Phone/Fax
| Phone: | 3039898169 |
| Fax: |
Provider Mailing Location
4849 LONE TREE WAY
SUITE C
ANTIOCH
CA
945318644
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |