Provider Demographics
NPI:1306327234
Name:O'NEILL, MICKAELA O'SULLIVAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MICKAELA
Middle Name:O'SULLIVAN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:8608 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5404
Mailing Address - Country:US
Mailing Address - Phone:732-796-8617
Mailing Address - Fax:
Practice Address - Street 1:8608 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5404
Practice Address - Country:US
Practice Address - Phone:623-979-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant