Provider Demographics
NPI:1275105215
Name:SULLIVAN, AMBER (FDN-P)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 UPTON DR STE 126-463
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1193
Mailing Address - Country:US
Mailing Address - Phone:757-895-2270
Mailing Address - Fax:
Practice Address - Street 1:2133 UPTON DR STE 126-463
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1193
Practice Address - Country:US
Practice Address - Phone:757-895-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date: