Provider Demographics
NPI:1134304645
Name:SULLIVAN, CATHERINE J (NP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 EXPRESSWAY DR N
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1316
Mailing Address - Country:US
Mailing Address - Phone:631-758-3336
Mailing Address - Fax:
Practice Address - Street 1:5537 EXPRESSWAY DR N
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1316
Practice Address - Country:US
Practice Address - Phone:631-758-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340126363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology