Healthcare Provider Details

I. General information

NPI: 1124529664
Provider Name (Legal Business Name): CHRISTINE M SULLIVAN MA, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date: 03/26/2020
Reactivation Date: 08/05/2024

III. Provider practice location address

864 CHURCH RD
SPRINGFIELD PA
19064-3911
US

IV. Provider business mailing address

864 CHURCH RD
SPRINGFIELD PA
19064-3911
US

V. Phone/Fax

Practice location:
  • Phone: 610-618-6420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005734
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: