MEDICARE: DR. MARIA A. SULLIVAN M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	194288	NY

General Provider Information

NPI Number	:	1437203999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA A. SULLIVAN M.D., PH.D.

Provider Business Mailing Address
First Line	:	4642 WALDO AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-3000
Country	:	US
Telephone Number	:	718-548-1661
Fax Number	:	212-543-6018

Provider Business Practice Location Address
First Line	:	140 RIVERSIDE DR # 1- O
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2605
Country	:	US
Telephone Number	:	212-678-9508
Fax Number	:	212-543-6018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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