Healthcare Provider Details

I. General information

NPI: 1558149237
Provider Name (Legal Business Name): TAYLOR SULLIVAN PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST STE 304
CAMBRIDGE MA
02138-5696
US

IV. Provider business mailing address

300 MOUNT AUBURN ST STE 304
CAMBRIDGE MA
02138-5696
US

V. Phone/Fax

Practice location:
  • Phone: 161-749-2062
  • Fax: 617-492-0631
Mailing address:
  • Phone: 161-749-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE CULTRERA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 781-820-2784