MEDICARE: MONIKA MAGDALENA 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	363LW0102X	Women's Health Nurse Practitioner	RN2287807	MA

General Provider Information

NPI Number	:	1346609955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIKA MAGDALENA SULLIVAN APRN

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST FL 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	325B KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2370
Country	:	US
Telephone Number	:	413-586-2496
Fax Number	:	413-923-5557

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	12/19/2025

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