Provider Demographics
NPI:1891312401
Name:ST CYR SULLIVAN, SERELEE EDITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SERELEE
Middle Name:EDITHA
Last Name:ST CYR SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 TEMPLE TERRACE HWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-6700
Mailing Address - Country:US
Mailing Address - Phone:813-796-5400
Mailing Address - Fax:813-776-0079
Practice Address - Street 1:8727 TEMPLE TERRACE HWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-6700
Practice Address - Country:US
Practice Address - Phone:813-796-5400
Practice Address - Fax:813-776-0079
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine