Provider Demographics
NPI:1255317988
Name:SULLIVAN, DANIEL P (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S HARBOR CITY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1964
Mailing Address - Country:US
Mailing Address - Phone:321-674-9094
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84610207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13379XOtherFL MEDICARE
FL13379XMedicare PIN
H66336Medicare UPIN