Provider Demographics
NPI:1922195320
Name:SULLIVAN, ROY F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6315
Mailing Address - Country:US
Mailing Address - Phone:516-294-0253
Mailing Address - Fax:516-640-5115
Practice Address - Street 1:50 WILLOW ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6315
Practice Address - Country:US
Practice Address - Phone:516-294-0253
Practice Address - Fax:516-640-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM00201Medicare ID - Type Unspecified