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General NPI Number Information
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NPI Number | 1710166632
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Entity Type | Individual
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Provider Name | EMILY S SULLIVAN P.A.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 2800 EISENHOWER AVE STE 220
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4587
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Country | US
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Telephone | 888-803-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 N 91ST ST STE A115
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5036
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Country | US
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Telephone | 888-803-3370
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110002695
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103770
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 64515
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PENDING
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License Number State | VA
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