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General NPI Number Information
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NPI Number | 1750683967
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Entity Type | Individual
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Provider Name | HEATHER B SULLIVAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1465 W CHANDLER BLVD BLDG A
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City | CHANDLER
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State | AZ
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Zip | 85224-6237
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Country | US
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Telephone | 480-786-8200
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Fax | 480-857-3005
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Provider Business Mailing Address
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Address Line | 2700 N CENTRAL AVE STE 1050
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City | PHOENIX
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State | AZ
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Zip | 85004-1217
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Country | US
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Telephone | 602-376-3353
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4756
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License Number State | AZ
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