Provider Demographics
NPI:1407056815
Name:SULLIVAN, KELLY ANN (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 CENTRAL BUSINESS PARK DR STE 1400
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2831
Mailing Address - Country:US
Mailing Address - Phone:757-756-5600
Mailing Address - Fax:757-904-1602
Practice Address - Street 1:7447 CENTRAL BUSINESS PARK DR STE 1400
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2831
Practice Address - Country:US
Practice Address - Phone:757-756-5600
Practice Address - Fax:757-904-1602
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022027832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry