Provider Demographics
NPI:1669496667
Name:SULLIVAN-WHALEN, MARY M (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:SULLIVAN-WHALEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 YORK AVE # 178
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6307
Mailing Address - Country:US
Mailing Address - Phone:212-327-7212
Mailing Address - Fax:212-327-8232
Practice Address - Street 1:1230 YORK AVE # 178
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6307
Practice Address - Country:US
Practice Address - Phone:212-327-7212
Practice Address - Fax:212-327-8232
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333426-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily