Individual
MAUREEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
17 W RED BANK AVE, SUITE 207, WOODBURY, NJ 08096-1630
(856) 845-0664
(856) 845-7602
Mailing address
15 CHATHAM DR, VOORHEES, NJ 08043-2953
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP000245
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP000245
LICENSE
NJ
01
—
MA003234L
MEDICAL LICENSE
PA
Enumeration date
07/11/2006
Last updated
11/20/2014
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