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Individual
LEN SULLIVAN
Active
Individual
LEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
00703
CT
363A00000X
Physician Assistant
Primary
PA11712
TX
363AM0700X
Medical Physician Assistant
902
MA
Other
Enumeration date
01/12/2007
Last updated
11/01/2023
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