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NPI Code Detail

MEDICARE: MS. AMANDA ROSE SULLIVAN BEHAVIOR TECHNICIAN

MEDICARE: MS. AMANDA ROSE SULLIVAN BEHAVIOR TECHNICIAN
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
1106S00000XBehavior TechnicianTX

General Provider Information

NPI Number : 1154264570
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA ROSE SULLIVAN BEHAVIOR TECHNICIAN
Provider Business Mailing Address
First Line : 4144 LAKEHURST CT
Second Line :
City : DALLAS
State : TX
Zip : 75211-3284
Country : US
Telephone Number : 214-270-9599
Fax Number :
Provider Business Practice Location Address
First Line : 1801 ROYAL LN STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75229-3765
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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