Provider Demographics
NPI:1043780364
Name:SULLIVAN, JENNIFER P (CBS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:P
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ARLINGTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1603
Mailing Address - Country:US
Mailing Address - Phone:845-473-5952
Mailing Address - Fax:
Practice Address - Street 1:33 ARLINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1603
Practice Address - Country:US
Practice Address - Phone:845-473-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN