Healthcare Provider Details

I. General information

NPI: 1902713431
Provider Name (Legal Business Name): SEAMUS SULLIVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 WINDERMERE AVE
LOS ANGELES CA
90041-1140
US

IV. Provider business mailing address

5213 WINDERMERE AVE
LOS ANGELES CA
90041-1140
US

V. Phone/Fax

Practice location:
  • Phone: 818-635-2898
  • Fax:
Mailing address:
  • Phone: 818-635-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: