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NPI Code Detail

MEDICARE: DELILAH SULLIVAN

MEDICARE: DELILAH SULLIVAN
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
1103K00000XBehavior Analyst2020009959MO

General Provider Information

NPI Number : 1518595263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELILAH SULLIVAN
Provider Business Mailing Address
First Line : 2644 METRO BLVD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2412
Country : US
Telephone Number : 314-395-9375
Fax Number : 314-942-1382
Provider Business Practice Location Address
First Line : 2644 METRO BLVD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2412
Country : US
Telephone Number : 314-395-9375
Fax Number : 314-942-1382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 03/30/2020

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