Healthcare Provider Details

I. General information

NPI: 1952504938
Provider Name (Legal Business Name): JENNIFER LYNN SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TAYLOR STATION RD STE 200
COLUMBUS OH
43213-4470
US

IV. Provider business mailing address

150 TAYLOR STATION RD STE 200
COLUMBUS OH
43213-4470
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-1300
  • Fax: 614-627-1304
Mailing address:
  • Phone: 614-627-1300
  • Fax: 614-627-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.154816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: