Healthcare Provider Details

I. General information

NPI: 1972454916
Provider Name (Legal Business Name): TRINITY JOY SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2692
US

IV. Provider business mailing address

22 SHADY GROVE DR
EAST AMHERST NY
14051-1609
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1000
  • Fax:
Mailing address:
  • Phone: 716-428-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: