Provider Demographics
NPI:1215952759
Name:SULLIVAN, NANCY ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-0338
Mailing Address - Country:US
Mailing Address - Phone:650-245-8685
Mailing Address - Fax:
Practice Address - Street 1:2555 PARK BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1924
Practice Address - Country:US
Practice Address - Phone:650-245-8685
Practice Address - Fax:650-847-7636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15181103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist