Provider Demographics
NPI:1023033396
Name:SULLIVAN, BARBARA (PNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WILLOW POND WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-377-0840
Mailing Address - Fax:585-377-9715
Practice Address - Street 1:21 WILLOW POND WAY
Practice Address - Street 2:STE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-377-0840
Practice Address - Fax:585-377-9715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380017163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109181DLOtherPREFERRED CARE