Healthcare Provider Details

I. General information

NPI: 1205654969
Provider Name (Legal Business Name): TERRI RYAN SULLIVAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONROE COMMUNITY HOSPITAL 435 E HENRIETTA RD
ROCHESTER NY
14620
US

IV. Provider business mailing address

24 HUNT HOLW
ROCHESTER NY
14624-4370
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6040
  • Fax:
Mailing address:
  • Phone: 585-794-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number021097-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: