Healthcare Provider Details

I. General information

NPI: 1518919836
Provider Name (Legal Business Name): ELEANOR R SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 UNDERPASS RD
BREWSTER MA
02631-1810
US

IV. Provider business mailing address

125 UNDERPASS RD
BREWSTER MA
02631-1810
US

V. Phone/Fax

Practice location:
  • Phone: 85-876-3777
  • Fax: 888-275-9498
Mailing address:
  • Phone: 508-876-3777
  • Fax: 888-275-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number72694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: