Healthcare Provider Details

I. General information

NPI: 1891048005
Provider Name (Legal Business Name): ANDREA D SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 11/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 MANCHESTER ROAD SUITE 213
SILVER SPRING MD
20901
US

IV. Provider business mailing address

8601 MANCHESTER ROAD SUITE 213
SILVER SPRING MD
20901
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-4545
  • Fax:
Mailing address:
  • Phone: 202-244-4545
  • Fax: 202-723-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP-0020
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: