Healthcare Provider Details

I. General information

NPI: 1609423748
Provider Name (Legal Business Name): ANISHMA K SINGH-SULLIVAN M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 TANOAK ST
HOLLISTER CA
95023-3129
US

IV. Provider business mailing address

590 TANOAK ST
HOLLISTER CA
95023-3129
US

V. Phone/Fax

Practice location:
  • Phone: 831-869-0447
  • Fax:
Mailing address:
  • Phone: 831-869-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76773
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-54321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: