Provider Demographics
NPI:1487643201
Name:SULLIVAN, DEBORAH ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:182 COLON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1405
Mailing Address - Country:US
Mailing Address - Phone:718-283-7148
Mailing Address - Fax:718-635-7442
Practice Address - Street 1:182 COLON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1405
Practice Address - Country:US
Practice Address - Phone:718-283-7148
Practice Address - Fax:718-635-7442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS