Healthcare Provider Details

I. General information

NPI: 1447160890
Provider Name (Legal Business Name): BRENDAN SULLIVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 OCEAN AVE
AVON BY THE SEA NJ
07717-1446
US

IV. Provider business mailing address

521 OCEAN AVE
AVON BY THE SEA NJ
07717-1446
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-8316
  • Fax:
Mailing address:
  • Phone: 908-309-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00236000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: