Provider Demographics
NPI:1871027052
Name:SULLIVAN, ADRIANA
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
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 1:1600 COIT RD STE 402
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6173
Mailing Address - Country:US
Mailing Address - Phone:972-612-8829
Mailing Address - Fax:972-612-2875
Practice Address - Street 1:1600 COIT RD STE 402
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6173
Practice Address - Country:US
Practice Address - Phone:972-612-8829
Practice Address - Fax:972-612-2875
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology