Healthcare Provider Details

I. General information

NPI: 1902197288
Provider Name (Legal Business Name): STEPHANIE ADELE SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 23RD AVE N STE 600
NASHVILLE TN
37203-1661
US

IV. Provider business mailing address

330 23RD AVE N STE 600
NASHVILLE TN
37203-1661
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-4640
  • Fax: 615-341-0988
Mailing address:
  • Phone: 615-340-4640
  • Fax: 615-341-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number0101264769
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number68384
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: