MEDICARE: AMINDA 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
1	251E00000X	Home Health Agency	31433601	PA

General Provider Information

NPI Number	:	1699227181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINDA SULLIVAN

Provider Business Mailing Address
First Line	:	2248 KIMBALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2524
Country	:	US
Telephone Number	:	610-606-8537
Fax Number	:	215-884-3718

Provider Business Practice Location Address
First Line	:	2248 KIMBALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2524
Country	:	US
Telephone Number	:	610-606-8537
Fax Number	:	215-884-3718

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	10/31/2016

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Directions to “ AMINDA SULLIVAN ” Practice Location

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