Provider Demographics
NPI:1710166632
Name:SULLIVAN, EMILY S (PA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:S
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 RICHMOND HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2157
Mailing Address - Country:US
Mailing Address - Phone:443-393-3653
Mailing Address - Fax:
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-370-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant