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Individual

DR. THERESA PAULETTE SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AUD

Contact information

Practice address
250 TUYTENBRIDGE RD, LAKE KATRINE, NY 12449-5429
(845) 336-7235
(845) 336-4726
Mailing address
513 PINE RD, COPAKE, NY 12516-1109
(518) 329-5761

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
001487
NY
235Z00000X
Speech-Language Pathologist
001886
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00473001
NY
Enumeration date
04/24/2007
Last updated
01/25/2011
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