Provider Demographics
NPI:1275589673
Name:MAUREEN SULLIVAN, MIDWIFE, PLLC
Entity Type:Organization
Organization Name:MAUREEN SULLIVAN, MIDWIFE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, MS
Authorized Official - Phone:607-433-7255
Mailing Address - Street 1:22 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2403
Mailing Address - Country:US
Mailing Address - Phone:607-433-7255
Mailing Address - Fax:607-432-0405
Practice Address - Street 1:22 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2403
Practice Address - Country:US
Practice Address - Phone:607-433-7255
Practice Address - Fax:607-432-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001104-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02494035Medicaid
NY02494035Medicaid