# DR. PATRICIA SUSANA SULLIVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1861455222
- **Gender:** F
- **Credential:** MD MPH

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 40062 | AZ | Yes |
| 208D00000X | General Practice Physician | 15987 | SC | — |

## Other

- **Enumeration date:** 04/07/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 159875 | — | SC |
| 01 | — | 2015987 | CDS | SC |
| 05 | — | 358212 | — | AZ |
| 01 | — | F427208066 | MEDICARE ID-TYPE UNSELECTED | — |