Provider Demographics
NPI:1023840717
Name:SULLIVAN, SHAMECKA (PMHNP)
Entity type:Individual
Prefix:
First Name:SHAMECKA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392552
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9500
Mailing Address - Country:US
Mailing Address - Phone:512-792-4402
Mailing Address - Fax:
Practice Address - Street 1:1000 NEIGHBORHOOD PL
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9697
Practice Address - Country:US
Practice Address - Phone:502-361-2381
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4024554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health