Individual
MARIAH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6537 JOHNSON RD, GLENFIELD, NY 13343-4120
(315) 571-4016
Mailing address
1738 THAYER HILL RD, BOONVILLE, NY 13309-1807
(315) 571-4016
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
577174
NY
Other
Enumeration date
04/01/2026
Last updated
04/01/2026
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