Healthcare Provider Details

I. General information

NPI: 1508265976
Provider Name (Legal Business Name): DANIEL SULLIVAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 W LANE AVE STE 220
COLUMBUS OH
43221-3919
US

IV. Provider business mailing address

1480 W LANE AVE STE 220
COLUMBUS OH
43221-3919
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-5500
  • Fax:
Mailing address:
  • Phone: 614-533-5500
  • Fax: 614-533-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP.09003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: