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NPI Code Detail

MEDICARE: MRS. AMY LYNN SULLIVAN

MEDICARE: MRS. AMY LYNN 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
1235Z00000XSpeech-Language Pathologist008553-1NY

General Provider Information

NPI Number : 1801328596
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY LYNN SULLIVAN
Provider Business Mailing Address
First Line : 1870 FACTORS WALK
Second Line :
City : IONIA
State : NY
Zip : 14475-9721
Country : US
Telephone Number : 585-424-0813
Fax Number :
Provider Business Practice Location Address
First Line : 4050 AVON RD
Second Line :
City : GENESEO
State : NY
Zip : 14454-9721
Country : US
Telephone Number : 585-243-3450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 03/31/2017

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Directions to “ MRS. AMY LYNN SULLIVAN ” Practice Location

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