Individual
CHARLES BRIAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
130 S PLYMOUTH AVE, ROCHESTER, NY 14614-2209
(585) 753-4183
Mailing address
130 S PLYMOUTH AVE, ROCHESTER, NY 14614-2213
(585) 753-4183
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405913-01
NY
Other
Enumeration date
06/10/2024
Last updated
07/09/2024
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