Provider Demographics
NPI:1720022171
Name:SULLIVAN, KIYOE WU (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KIYOE
Middle Name:WU
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:QINGFANG
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:12 PARKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3602
Mailing Address - Country:US
Mailing Address - Phone:913-636-2955
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3894
Practice Address - Country:US
Practice Address - Phone:203-852-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250272207ZP0102X
CT69837207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology