MEDICARE: CAROL A SULLIVAN M.S.

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	235Z00000X	Speech-Language Pathologist	000649-1	NY

General Provider Information

NPI Number	:	1659492338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A SULLIVAN M.S.

Provider Business Mailing Address
First Line	:	50 WILLOW ST
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6315
Country	:	US
Telephone Number	:	516-294-0253
Fax Number	:	516-640-5115

Provider Business Practice Location Address
First Line	:	50 WILLOW ST
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6315
Country	:	US
Telephone Number	:	516-294-0253
Fax Number	:	516-640-5115

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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Directions to “ CAROL A SULLIVAN M.S.” Practice Location

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