Healthcare Provider Details

I. General information

NPI: 1407856727
Provider Name (Legal Business Name): SARAH A SULLIVAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. SARAH A BURNHAM

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 EASTERN BLVD
BALTIMORE MD
21221-3422
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4700
  • Fax: 410-780-0364
Mailing address:
  • Phone: 410-558-4888
  • Fax: 410-327-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR167579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: