Provider Demographics
NPI:1346734530
Name:SULLIVAN, SABINA MARY (CF-SLP)
Entity Type:Individual
Prefix:
First Name:SABINA
Middle Name:MARY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N SUFFOLK AVE # 2
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1861
Mailing Address - Country:US
Mailing Address - Phone:201-421-7311
Mailing Address - Fax:
Practice Address - Street 1:144 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2141
Practice Address - Country:US
Practice Address - Phone:609-465-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist