Provider Demographics
NPI:1093334344
Name:SULLIVAN, DEVIN MARIE (DO)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2076
Mailing Address - Country:US
Mailing Address - Phone:302-623-0200
Mailing Address - Fax:302-623-0117
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 1250
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2076
Practice Address - Country:US
Practice Address - Phone:302-623-0200
Practice Address - Fax:302-623-0117
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0024521208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics