Healthcare Provider Details

I. General information

NPI: 1427589076
Provider Name (Legal Business Name): KAYLEIGH SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF MEDICINE
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1070
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number22403
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: