Individual
KELLY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
275 GEORGE ST, BRIDGEPORT, CT 06604-3320
(203) 576-8462
Mailing address
6 FOX RUN, WILTON, CT 06897-1110
(203) 576-8461
(203) 332-5641
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
002446
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002446
LICENSE
CT
Enumeration date
02/28/2008
Last updated
02/28/2008
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