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General NPI Number Information
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NPI Number | 1639487952
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Entity Type | Individual
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Provider Name | SANDRA EBERLE SULLIVAN NP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 320 SANTA FE DR SUITE 308
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City | ENCINITAS
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State | CA
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Zip | 92024-5138
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Country | US
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Telephone | 760-230-5188
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Fax | 760-230-5203
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | CARDIFF BY THE SEA
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State | CA
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Zip | 92007-0429
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Country | US
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Telephone | 760-230-5188
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Fax | 760-230-5203
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP19940
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License Number State | CA
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