MEDICARE: SARAH FELICIA 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	235Z00000X	Speech-Language Pathologist	19254	FL
2	235Z00000X	Speech-Language Pathologist	01214L	MD
3	235Z00000X	Speech-Language Pathologist	08337	MD

General Provider Information

NPI Number	:	1831546183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH FELICIA SULLIVAN

Provider Business Mailing Address
First Line	:	313 SONGWOOD CT
Second Line	:
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-2417
Country	:	US
Telephone Number	:	443-623-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	9027 ROYAL RIVER CIR
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-3221
Country	:	US
Telephone Number	:	443-623-0223
Fax Number	:

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

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	07/12/2021

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