Healthcare Provider Details

I. General information

NPI: 1184548356
Provider Name (Legal Business Name): DIANNA SULLIVAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROUTE 109 STE A
LINDENHURST NY
11757-1158
US

IV. Provider business mailing address

910 ROUTE 109 STE A
LINDENHURST NY
11757-1158
US

V. Phone/Fax

Practice location:
  • Phone: 631-991-3235
  • Fax: 631-631-3970
Mailing address:
  • Phone: 631-991-3235
  • Fax: 631-631-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number360123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: