Provider Demographics
NPI:1417303223
Name:SULLY, GERALDE
Entity Type:Individual
Prefix:
First Name:GERALDE
Middle Name:
Last Name:SULLY
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 1:4141 ELY AVE
Mailing Address - Street 2:1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2033
Mailing Address - Country:US
Mailing Address - Phone:347-781-2731
Mailing Address - Fax:
Practice Address - Street 1:4141 ELY AVE
Practice Address - Street 2:1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2033
Practice Address - Country:US
Practice Address - Phone:347-781-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse