MEDICARE: TYLER SULLIVAN SLP

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1982562922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER SULLIVAN SLP

Provider Business Mailing Address
First Line	:	3330 MIDVALE DR APT 1102
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-5288
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 SOUND RD STE 200
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-7813
Country	:	US
Telephone Number	:	910-541-3636
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ TYLER SULLIVAN SLP” Practice Location

Language	Start Address	Practice Location

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