=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104070382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. NADINE ANN O'SULLIVAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2008
-----------------------------------------------------
Last Update Date | 11/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 BETHPAGE RD
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-932-7414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1753 QUEEN ST
-----------------------------------------------------
City | NORTH BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-2838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-221-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 011116-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------