Provider Demographics
NPI:1972315034
Name:SULLIVAN, SARAH L
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:L
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 1:95 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-4229
Mailing Address - Country:US
Mailing Address - Phone:315-806-6714
Mailing Address - Fax:
Practice Address - Street 1:1323 COUNTY ROUTE 9
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4892
Practice Address - Country:US
Practice Address - Phone:315-591-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide