Provider Demographics
NPI:1427327626
Name:SHARON SULLIVAN PT MS PC
Entity type:Organization
Organization Name:SHARON SULLIVAN PT MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-878-7012
Mailing Address - Street 1:225 MONTAUK HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1425
Mailing Address - Country:US
Mailing Address - Phone:631-878-7012
Mailing Address - Fax:631-878-7015
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1425
Practice Address - Country:US
Practice Address - Phone:631-878-7012
Practice Address - Fax:631-878-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty