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General NPI Number Information
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NPI Number | 1427269562
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Entity Type | Individual
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Provider Name | PATRICIA ANN SULLIVAN F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 24 GARDNER AVE MIDDLETOWN HIGH SCHOOL
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City | MIDDLETOWN
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State | NY
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Zip | 10940-3240
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Country | US
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Telephone | 845-326-1259
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Fax |
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Provider Business Mailing Address
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Address Line | 39 TWIN ISLAND CIR
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City | WALDEN
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State | NY
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Zip | 12586-2819
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Country | US
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Telephone | 845-778-0632
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F3303441
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License Number State | NY
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