Provider Demographics
NPI:1801232087
Name:SULLIVAN, ANN MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:TUFARIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:300 GLEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2421
Mailing Address - Country:US
Mailing Address - Phone:631-654-8171
Mailing Address - Fax:
Practice Address - Street 1:335 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1143
Practice Address - Country:US
Practice Address - Phone:631-589-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist