# WENDY S. SULLIVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1194781617
- **Gender:** F
- **Credential:** P.A.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 0110 002181 | VA | Yes |
| 363A00000X | Physician Assistant | C0002516 | MD | — |

## Other

- **Enumeration date:** 04/24/2006
- **Last updated:** 11/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010234085 | — | VA |
| 01 | — | 541203530 | TAS IDENTIFICATION NUMBER | VA |