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NPI Code Detail

MEDICARE: MISS KAYLA DANIELLE SULLIVAN M.S., CCC-SLP

MEDICARE: MISS KAYLA DANIELLE SULLIVAN M.S., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist027844NY

General Provider Information

NPI Number : 1164902490
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KAYLA DANIELLE SULLIVAN M.S., CCC-SLP
Provider Business Mailing Address
First Line : 71 CLEVELAND AVE
Second Line :
City : FREDONIA
State : NY
Zip : 14063-1954
Country : US
Telephone Number : 716-785-9112
Fax Number :
Provider Business Practice Location Address
First Line : 7755 ROUTE 83
Second Line :
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-988-3291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2018
Last Update Date : 08/16/2018

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