Provider Demographics
NPI:1093468050
Name:SULLIVAN, JULIE MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9561
Mailing Address - Country:US
Mailing Address - Phone:716-310-4403
Mailing Address - Fax:
Practice Address - Street 1:8949 HAMMOND DR
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9561
Practice Address - Country:US
Practice Address - Phone:716-310-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403933-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health