Provider Demographics
NPI:1790118230
Name:HUGGINS-SULLIVAN, SIOBHAN AS (ATC)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:AS
Last Name:HUGGINS-SULLIVAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CEDAR AVE
Mailing Address - Street 2:MONMOUTH UNIVERSITY SPORTS MEDICINE
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1804
Mailing Address - Country:US
Mailing Address - Phone:732-263-5249
Mailing Address - Fax:732-263-5265
Practice Address - Street 1:400 CEDAR AVE
Practice Address - Street 2:MONMOUTH UNIVERSITY SPORTS MEDICINE
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1804
Practice Address - Country:US
Practice Address - Phone:732-263-5249
Practice Address - Fax:732-263-5265
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001897002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer