Healthcare Provider Details

I. General information

NPI: 1528311438
Provider Name (Legal Business Name): DAIRA E SULLIVAN M.S.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 ALAN DR
WANTAGH NY
11793-1041
US

IV. Provider business mailing address

903 ALAN DR
WANTAGH NY
11793-1041
US

V. Phone/Fax

Practice location:
  • Phone: 516-826-4253
  • Fax:
Mailing address:
  • Phone: 516-826-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: