Healthcare Provider Details

I. General information

NPI: 1134033442
Provider Name (Legal Business Name): MAUREEN MARIE SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SYLVANIA AVE
SYLVANIA OH
43560-9578
US

IV. Provider business mailing address

4909 BURKEWOOD CT APT 101
SYLVANIA OH
43560-3004
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-8680
  • Fax: 419-824-8690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.381020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: