Healthcare Provider Details

I. General information

NPI: 1154983740
Provider Name (Legal Business Name): DANIEL F SULLIVAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 MEDCOM ST
NORTH CHARLESTON SC
29406-9167
US

IV. Provider business mailing address

9100 MEDCOM ST
NORTH CHARLESTON SC
29406-9167
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5151014127
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number94680
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76201
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: