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Individual

DR. ANDRE JAWANN SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
325 MDG, 340 MAGNOLIA CIRCLE, TYNDALL AFB, FL 32403
(703) 731-2566
Mailing address
325 MDG, 340 MAGNOLIA CIRCLE, TYNDALL AFB, FL 32403
(703) 731-2566

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
41880
TN
2084P0800X
Psychiatry Physician
036.175093
IL
2084P0800X
Psychiatry Physician
M-16066
ID
2084P0800X
Psychiatry Physician
Primary
R9446
TX

Other

Enumeration date
01/22/2007
Last updated
04/21/2026
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