Provider Demographics
NPI:1831546183
Name:SULLIVAN, SARAH FELICIA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FELICIA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SONGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2417
Mailing Address - Country:US
Mailing Address - Phone:443-623-0223
Mailing Address - Fax:
Practice Address - Street 1:9027 ROYAL RIVER CIR
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3221
Practice Address - Country:US
Practice Address - Phone:443-623-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19254235Z00000X
MD01214L235Z00000X
MD08337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist