Provider Demographics
NPI:1316392491
Name:SULLIVAN, NORMA CECILIA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:CECILIA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 98TH ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1407
Mailing Address - Country:US
Mailing Address - Phone:718-592-8275
Mailing Address - Fax:
Practice Address - Street 1:6115 98TH ST APT 1J
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1407
Practice Address - Country:US
Practice Address - Phone:718-592-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315747390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program