Provider Demographics
NPI:1619555380
Name:O'SULLIVAN, JACQUELYN ERIN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ERIN
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-6378
Mailing Address - Fax:
Practice Address - Street 1:260 COCHITUATE RD STE 102
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4608
Practice Address - Country:US
Practice Address - Phone:508-532-7510
Practice Address - Fax:508-532-7513
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023694207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology