Healthcare Provider Details

I. General information

NPI: 1730339912
Provider Name (Legal Business Name): AMY K SULLIVAN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE SUITE 404
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2554
  • Fax:
Mailing address:
  • Phone: 850-475-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME127650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: