# MEGAN ALISE SULLIVAN

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

## Provider details

- **NPI number:** 1790272466
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 064286 | NY | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 331335 | NY | Yes |

## Other

- **Enumeration date:** 04/18/2018
- **Last updated:** 02/20/2025