Provider Demographics
NPI:1194031179
Name:MAUREEN M. SULLIVAN, P.A.
Entity Type:Organization
Organization Name:MAUREEN M. SULLIVAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-743-8797
Mailing Address - Street 1:390 TEQUESTA DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3085
Mailing Address - Country:US
Mailing Address - Phone:561-743-8797
Mailing Address - Fax:561-743-9290
Practice Address - Street 1:390 TEQUESTA DR
Practice Address - Street 2:SUITE G
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3085
Practice Address - Country:US
Practice Address - Phone:561-743-8797
Practice Address - Fax:561-743-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22119Medicare UPIN