MEDICARE: MS. DENISE LUISE SULLIVAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F304055	NY

General Provider Information

NPI Number	:	1104996164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE LUISE SULLIVAN APRN

Provider Business Mailing Address
First Line	:	2217 SULTANA DR
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	JACOBI MEDICAL CENTER BUILDING 1 ROOM 1226
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	718-918-6867
Fax Number	:	718-918-7902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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