Provider Demographics
NPI:1508983966
Name:SULLIVAN, SHARON ELIZABETH (PT, MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1903
Mailing Address - Country:US
Mailing Address - Phone:631-874-0103
Mailing Address - Fax:
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1425
Practice Address - Country:US
Practice Address - Phone:631-878-7012
Practice Address - Fax:631-878-7015
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015098225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic