Provider Demographics
NPI:1346778925
Name:SULLIVAN, YOLANDA LEE
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SHERMAN GRV
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1429
Mailing Address - Country:US
Mailing Address - Phone:508-847-0106
Mailing Address - Fax:
Practice Address - Street 1:45 SHERMAN GRV
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1429
Practice Address - Country:US
Practice Address - Phone:508-847-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program