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General NPI Number Information
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NPI Number | 1942209333
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Entity Type | Individual
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Provider Name | EDWARD M SULLIVAN PA
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 341 WHEATFIELD DR SUITE 190
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City | SUNNYVALE
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State | TX
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Zip | 75182-4638
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Country | US
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Telephone | 972-686-8200
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Fax | 972-686-7711
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Provider Business Mailing Address
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Address Line | 3209 WILLOW BND
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City | BEDFORD
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State | TX
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Zip | 76021-3836
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Country | US
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Telephone | 972-686-8200
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Fax | 972-686-7711
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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 | PA01111
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License Number State | TX
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