Provider Demographics
NPI:1386669687
Name:SULLIVAN, JUNE MARIE (PA)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20521-0001
Mailing Address - Country:US
Mailing Address - Phone:202-663-1779
Mailing Address - Fax:202-663-1939
Practice Address - Street 1:2401 E ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20521-0001
Practice Address - Country:US
Practice Address - Phone:202-663-1779
Practice Address - Fax:202-663-1939
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA200002120363AM0700X
SC3655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP96286Medicare UPIN