Healthcare Provider Details

I. General information

NPI: 1063336527
Provider Name (Legal Business Name): SEAN SULLIVAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

26 OAKDALE ST
WEYMOUTH MA
02190-1430
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-6344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2301278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: