Provider Demographics
NPI:1972184588
Name:SULLIVAN, ADINA (RN)
Entity type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MUR PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2934
Mailing Address - Country:US
Mailing Address - Phone:631-972-2457
Mailing Address - Fax:631-972-1547
Practice Address - Street 1:2 MUR PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2934
Practice Address - Country:US
Practice Address - Phone:631-972-2457
Practice Address - Fax:631-972-1547
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635924-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY635924-1OtherREGISTERED NURSE