Individual
BENJAMIN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 HILLS BEACH RD, BIDDEFORD, ME 04005-9526
(716) 580-0705
Mailing address
210 OEHMAN BLVD, CHEEKTOWAGA, NY 14225-1643
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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