Provider Demographics
NPI:1477162725
Name:SULLIVAN, AIDAN (PA)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4513
Mailing Address - Country:US
Mailing Address - Phone:828-255-7733
Mailing Address - Fax:828-258-3084
Practice Address - Street 1:30 CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4513
Practice Address - Country:US
Practice Address - Phone:828-255-7733
Practice Address - Fax:828-258-3084
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025426363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical