Provider Demographics
NPI:1811566870
Name:SULLIVAN, ASHLEY DARROW
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DARROW
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MAGUIRE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7266
Mailing Address - Country:US
Mailing Address - Phone:803-837-3637
Mailing Address - Fax:
Practice Address - Street 1:963 PLYMOUTH AVE S APT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2905
Practice Address - Country:US
Practice Address - Phone:803-837-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341425164W00000X
SC52326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse