Individual
ANSLEY DEVORE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202MUH, CHARLESTON, SC 29425-1518
(843) 792-7365
Mailing address
169 ASHLEY AVE RM 202MUH, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
93053
SC
207R00000X
Internal Medicine Physician
93053
SC
207R00000X
Internal Medicine Physician
LL90304
SC
Other
Enumeration date
06/26/2023
Last updated
07/17/2025
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