Healthcare Provider Details

I. General information

NPI: 1013732072
Provider Name (Legal Business Name): MEGAN EMILY SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 CANE CREEK RD
FAIRVIEW NC
28730-8743
US

IV. Provider business mailing address

26 HUNTINGTON ST
ASHEVILLE NC
28801-3716
US

V. Phone/Fax

Practice location:
  • Phone: 828-628-2800
  • Fax:
Mailing address:
  • Phone: 407-595-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30003486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: