Provider Demographics
NPI:1528562659
Name:SULLIVAN, KELSEY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MICHELLE
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1497 SHADOW OAKS PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1448
Mailing Address - Country:US
Mailing Address - Phone:802-376-4474
Mailing Address - Fax:
Practice Address - Street 1:300 HALKET ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3108
Practice Address - Country:US
Practice Address - Phone:412-641-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012720982080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine