MEDICARE: PAULA A SULLIVAN PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	20040129	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811000169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA A SULLIVAN PHD

Provider Business Mailing Address
First Line	:	PO BOX 1026
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1026
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	1002 WISHARD BLVD STE 2120
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2872
Country	:	US
Telephone Number	:	317-944-8162
Fax Number	:	317-944-9760

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/20/2020

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Directions to “ PAULA A SULLIVAN PHD” Practice Location

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