Provider Demographics
NPI:1033506951
Name:SULLIVAN, VICTORIA (IBCLC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2881
Mailing Address - Country:US
Mailing Address - Phone:917-742-2659
Mailing Address - Fax:
Practice Address - Street 1:3933 LYNN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2881
Practice Address - Country:US
Practice Address - Phone:917-742-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11111419174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN