Healthcare Provider Details

I. General information

NPI: 1871887562
Provider Name (Legal Business Name): KAREN DOROTHY SULLIVAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR CB 7200
CHAPEL HILL NC
27599-4817
US

IV. Provider business mailing address

5505 OLD GREENSBORO RD
CHAPEL HILL NC
27516-4817
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-9868
  • Fax: 919-966-0083
Mailing address:
  • Phone: 919-619-1772
  • Fax: 919-966-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4151
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: