Provider Demographics
NPI:1669869038
Name:SULLIVAN, ASHLEY ANNE (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANNE
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 1:7113 THREE CHOPT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3643
Mailing Address - Country:US
Mailing Address - Phone:804-282-4205
Mailing Address - Fax:804-673-6432
Practice Address - Street 1:7113 THREE CHOPT RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-4205
Practice Address - Fax:804-673-6432
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics