MR. SHANE SULLAWAY (NPI# 1366738320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366738320 |
| Entity Type | Individual |
| Full Name | MR. SHANE SULLAWAY |
| Practice Address |
2100 N Highway 360 Ste. 1802 Grand Prairie TX 75050-1011 |
| Practice Telephone | 9726478567 |
| Practice Fax Number | 9726604548 |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247200000X | Technician, Other | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 247200000X | 05 |
| Street Address |
2100 N HIGHWAY 360 STE. 1802 |
| City | GRAND PRAIRIE |
| State | TX |
| Zip Code | 75050-1011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235282294 | Dickson Kutey | Durable Medical Equipment & Medical Supplies | 2100 N Highway 360, Suite 301, Grand Prairie, TX 75050-1009 | 2007-01-20 |
| 1639460462 | Gary Rodgers | Technician, Other | 2100 N Highway 360, Suite 1802, Grand Prairie, TX 75050-1011 | 2011-04-27 |
| 1114255254 | Stellar Healthcare Services, LLC | Case Manager/Care Coordinator | 2100 N Highway 360, Suite 1105, Grand Prairie, TX 75050-1011 | 2009-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225539695 | Christopher Bachman | Physical Therapy Assistant | 2045 Hwy 360, #100b, Grand Prarie, TX 75050 | 2018-02-21 |
| 1003335233 | L & B Group Home LLC | In Home Supportive Care | 605 E Palace Pkwy Ste, B4, Grand Prairie, TX 75050 | 2017-09-19 |
| 1073054748 | Smileeasy Dental Grand Prairie, Pllc | Dentist | 2650 S Hwy 161, Grand Prairie, TX 75050 | 2017-03-15 |
| 1164966651 | Prime Diagnostic Imaging of Irving, LLC | Clinic/Center | 2210 Paddock Way, Grand Prairie, TX 75050 | 2016-12-19 |
| 1366801037 | Monica Simpson | Counselor | 2080 N Hwy 360, Ste 430, Grand Prairie, TX 75050 | 2016-02-23 |
| 1437545845 | Stateserv Medical of Texas | Durable Medical Equipment & Medical Supplies | 1000 Post and Paddock Street, #305, Grand Prairie, TX 75050 | 2015-04-13 |
| 1912304593 | Tenishia Chintankwa | Non-emergency Medical Transport (VAN) | 2403 Doreen St, Grand Prairie, TX 75050 | 2014-11-26 |
| 1780023192 | Holland Surgical Group | Physician Assistant | 201 West Tarrant Rd. #1420, Grand Prairie, TX 75050 | 2013-06-19 |
| 1174962823 | Occumed Plus-grand Prairie | General Practice | 805 W. North Carrier Pkwy, 260, Grand Prairie, TX 75050 | 2013-06-17 |
| 1497099618 | Sorai Susanne S Stuart | Counselor | 2825 N. State Hwy 360, 710, Grand Prairie, TX 75050 | 2012-11-15 |
| Find all providers in zip 75050 | ||||
| Taxonomy Code | 247200000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Technician, Other |
| A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. |
| Notes: Sources: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988; Dorland’s Illustrated Medical Dictionary, 26th Edition. Philadelphia: W.B. Saunders Company, 1981; and Webster’s II New Riverside University Dictionary. Boston: Riverside Publishing Company, 1984. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790077865 | Ron Seely | Technician, Other | 1517 W North Carrier Pkwy, #110, Grand Prairie, TX 75050-1288 | 2011-05-09 |
| 1831625862 | Raymond Dale Deshazer | Technician, Other | 2001 108th St, Ste 104, Grand Prairie, TX 75050-1437 | 2017-05-11 |
| 1336431410 | Stephen Walter Brewton | Technician, Other | 1517 W North Carrier Pkwy, Suite110, Grand Prairie, TX 75050-1288 | 2011-05-09 |
| 1639460462 | Gary Rodgers | Technician, Other | 2100 N Highway 360, Suite 1802, Grand Prairie, TX 75050-1011 | 2011-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174120083 | Pablo Gonzales IIi | Technician, Other | 10114 Stella Link Rd Ste A-2, Houston, TX 77025-5300 | 2020-10-04 |
| 1477160315 | Kaili Kennedy | Technician, Other | 66 Daughtrey Ave Apt 516, Waco, TX 76706-1677 | 2020-09-24 |
| 1194338673 | Porscha Williams | Technician, Other | 2520 Echo Point Dr, Fort Worth, TX 76123-1136 | 2020-08-25 |
| 1245857580 | Tara Latonya Cooper | Technician, Other | 1743 Troup Hwy, Tyler, TX 75701-5869 | 2020-07-02 |
| 1295351914 | Richard Allen Majors | Technician, Other | 6429 Green Ridge Dr, Watauga, TX 76148-1414 | 2020-06-18 |
| 1740824804 | Sara Wolfe | Technician, Other | 4245 N Central Expy Ste 450, Dallas, TX 75205-4530 | 2019-11-01 |
| 1265075048 | Juliana Dubey | Technician, Other | 400 E. Royal Ln, Building 3, Suite 290, Irving, TX 75039 | 2019-10-23 |
| 1154963007 | Alex Robert Langford | Technician, Other | 1901 N. Glenville Dr., Suite 501, Richardson, TX 75081 | 2019-10-11 |
| 1518517762 | Clayton Ernest Robertson | Technician, Other | 5555 N Lamar Blvd Ste D113, Austin, TX 78751-1075 | 2019-09-18 |
| 1013561778 | Joslyn Love | Technician, Other | 1228 Timber Ln, Frisco, TX 75036-1743 | 2019-07-30 |
| Find all providers with the same taxonomy | ||||
| City | GRAND PRAIRIE |
| Zip Code | 75050 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.