Healthcare Provider Details

I. General information

NPI: 1952885360
Provider Name (Legal Business Name): DARBY SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 AVENUE O NE
WINTER HAVEN FL
33881-2409
US

IV. Provider business mailing address

1229 VIA DEL MAR
WINTER PARK FL
32789-1364
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-3103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: