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NPI Code Detail

MEDICARE: DR. SERELEE EDITHA ST CYR SULLIVAN MD

MEDICARE: DR. SERELEE EDITHA ST CYR SULLIVAN MD
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
1207R00000XInternal Medicine PhysicianME159637FL

Other Identifiers

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

General Provider Information

NPI Number : 1891312401
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SERELEE EDITHA ST CYR SULLIVAN MD
Provider Business Mailing Address
First Line : 8727 TEMPLE TERRACE HWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-6700
Country : US
Telephone Number : 813-796-5400
Fax Number : 813-776-0079
Provider Business Practice Location Address
First Line : 8727 TEMPLE TERRACE HWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-6700
Country : US
Telephone Number : 813-796-5400
Fax Number : 813-776-0079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 08/16/2023

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Directions to “ DR. SERELEE EDITHA ST CYR SULLIVAN MD” Practice Location

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