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NPI Code Detail

MEDICARE: KENYUNA SULLIVAN

MEDICARE: KENYUNA 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 Pathologist108839TX

General Provider Information

NPI Number : 1942459706
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENYUNA SULLIVAN
Provider Business Mailing Address
First Line : 1200 SILENT STAR LN
Second Line :
City : DENTON
State : TX
Zip : 76210-3896
Country : US
Telephone Number : 214-972-8844
Fax Number :
Provider Business Practice Location Address
First Line : 205 N BONNIE BRAE ST
Second Line :
City : DENTON
State : TX
Zip : 76201-3766
Country : US
Telephone Number : 940-373-4766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2008
Last Update Date : 06/20/2023

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Directions to “ KENYUNA SULLIVAN ” Practice Location

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