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General NPI Number Information
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NPI Number | 1518919836
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Entity Type | Individual
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Provider Name | ELEANOR R SULLIVAN MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 125 UNDERPASS RD
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City | BREWSTER
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State | MA
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Zip | 02631-1810
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Country | US
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Telephone | 85-876-3777
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Fax | 888-275-9498
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Provider Business Mailing Address
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Address Line | 125 UNDERPASS RD
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City | BREWSTER
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State | MA
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Zip | 02631-1810
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Country | US
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Telephone | 508-876-3777
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Fax | 888-275-9498
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 72694
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License Number State | MA
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