Healthcare Provider Details

I. General information

NPI: 1861343543
Provider Name (Legal Business Name): KELLYCULLIVAN SUCCAR ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 02/07/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GEORGE WASHINGTON BLVD STE 1
HULL MA
02045-3001
US

IV. Provider business mailing address

83 MONCRIEF RD
ROCKLAND MA
02370-1527
US

V. Phone/Fax

Practice location:
  • Phone: 781-925-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND10026
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: