Individual
DANIEL P SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
930 S HARBOR CITY BLVD STE 200, MELBOURNE, FL 32901-1964
(321) 674-9094
(321) 674-9289
Mailing address
930 S HARBOR CITY BLVD STE 200, MELBOURNE, FL 32901-1964
(321) 674-9094
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME84610
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13379X
FL MEDICARE
FL
Enumeration date
12/15/2005
Last updated
01/26/2022
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