Provider Demographics
NPI:1265496905
Name:SULLIVAN, ANDREA N (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name: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 1:3535 GARRETT DR
Mailing Address - Street 2:CROSSOVER HEALTH MEDICAL GROUP
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2811
Mailing Address - Country:US
Mailing Address - Phone:408-986-7777
Mailing Address - Fax:408-297-6509
Practice Address - Street 1:3535 GARRETT DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2811
Practice Address - Country:US
Practice Address - Phone:408-986-7777
Practice Address - Fax:408-297-6509
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00087MOtherNHIC
MMM00087MOtherNHIC
OOA738421Medicare ID - Type Unspecified