Provider Demographics
NPI:1902197288
Name:SULLIVAN, STEPHANIE ADELE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ADELE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 23RD AVE N STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1661
Mailing Address - Country:US
Mailing Address - Phone:615-340-4640
Mailing Address - Fax:615-341-0988
Practice Address - Street 1:330 23RD AVE N STE 600
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1661
Practice Address - Country:US
Practice Address - Phone:615-340-4640
Practice Address - Fax:615-341-0988
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101264769207VX0201X
TN68384207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology