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General NPI Number Information
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NPI Number | 1184184574
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Entity Type | Individual
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Provider Name | VICTORIA ANNE SULLIVAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 30 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29425-8910
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Country | US
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Telephone | 843-792-9451
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 FOREST DR APT 1210
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City | COLUMBIA
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State | SC
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Zip | 29206-6500
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Country | US
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Telephone | 803-840-2325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 82725
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License Number State | SC
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