Healthcare Provider Details

I. General information

NPI: 1508421298
Provider Name (Legal Business Name): SARAH DOERR SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20110 VASHON HWY SW
VASHON WA
98070-6026
US

IV. Provider business mailing address

18019 BEALL RD SW
VASHON WA
98070-5321
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-5511
  • Fax:
Mailing address:
  • Phone: 206-999-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: