Provider Demographics
NPI:1275712580
Name:SULLIVAN, BRENDA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 YONKERS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3060
Mailing Address - Country:US
Mailing Address - Phone:914-237-1260
Mailing Address - Fax:
Practice Address - Street 1:955 YONKERS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3060
Practice Address - Country:US
Practice Address - Phone:914-237-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26E592Medicare PIN
NYA61691Medicare UPIN