Provider Demographics
NPI:1285036707
Name:SULLIVAN, MICHELLE SUZANNE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:420 E 70TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5320
Mailing Address - Country:US
Mailing Address - Phone:646-962-3108
Mailing Address - Fax:646-926-1609
Practice Address - Street 1:420 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5320
Practice Address - Country:US
Practice Address - Phone:646-962-3108
Practice Address - Fax:646-906-1609
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant