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General NPI Number Information
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NPI Number | 1578948295
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Entity Type | Individual
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Provider Name | KERI SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 175 MIDDLE ST SUITE 1201
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City | LAKE MARY
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State | FL
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Zip | 32746-3625
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Country | US
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Telephone | 315-447-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 8303 SPOTTER DR
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City | APEX
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State | NC
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Zip | 27502-2458
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Country | US
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Telephone | 315-447-3617
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11518907
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License Number State | NC
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