Healthcare Provider Details

I. General information

NPI: 1841046430
Provider Name (Legal Business Name): BRITTANY NICOLE SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CHRYSLER SERVICE DRIVE
DETROIT MI
48201-2167
US

IV. Provider business mailing address

3901 CHRYSLER SERVICE DRIVE
DETROIT MI
48201-2167
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-6732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301517913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: