Provider Demographics
NPI:1558397182
Name:SULLIVAN, DANIEL B (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5879
Mailing Address - Country:US
Mailing Address - Phone:561-400-2729
Mailing Address - Fax:561-374-5717
Practice Address - Street 1:2815 S SEACREST BLVD
Practice Address - Street 2:BETHESDA MEMORIAL HOSPITAL
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7934
Practice Address - Country:US
Practice Address - Phone:561-737-7733
Practice Address - Fax:561-374-5717
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6041207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44456OtherBCBS FL
FL255004100Medicaid
FL050065891Medicare PIN
FL44456OtherBCBS FL
FL44456UMedicare PIN
FL44456ZMedicare PIN
FL44456WMedicare PIN
FLP00074178Medicare PIN
FL050065056Medicare PIN
FL44456VMedicare PIN
FLE66821Medicare UPIN
FL255004100Medicaid
FLP00433431Medicare PIN