Individual
MALLORY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
117 W MAIN ST, SUITE 1, WATERVILLE, NY 13480-1165
(315) 841-4178
(315) 841-4338
Mailing address
117 W MAIN ST, SUITE 1, WATERVILLE, NY 13480-1165
(315) 841-4178
(315) 841-4338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
274601
NY
Other
Enumeration date
05/20/2011
Last updated
03/20/2017
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