Healthcare Provider Details

I. General information

NPI: 1487731204
Provider Name (Legal Business Name): JENNIFER O'SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 WESTBANK EXPY STE A
HARVEY LA
70058-4364
US

IV. Provider business mailing address

2712 ESPLANADE AVE
NEW ORLEANS LA
70119-3333
US

V. Phone/Fax

Practice location:
  • Phone: 504-582-0715
  • Fax: 504-582-0716
Mailing address:
  • Phone: 601-955-3614
  • Fax: 504-264-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number305136
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19346
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: