Provider Demographics
NPI:1154074466
Name:SULLIVAN SINUS AND ALLERGY, LLC
Entity Type:Organization
Organization Name:SULLIVAN SINUS AND ALLERGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-674-9094
Mailing Address - Street 1:116 OCEAN TER
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3417
Mailing Address - Country:US
Mailing Address - Phone:321-674-9094
Mailing Address - Fax:321-674-9289
Practice Address - Street 1:930 S HARBOR CITY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1964
Practice Address - Country:US
Practice Address - Phone:321-674-9094
Practice Address - Fax:321-674-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty