Individual
MRS. KELLY O'SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 SILENT MEADOW LN, DEPT OF MEDICINE, LANCASTER, NY 14086-3430
(716) 391-0937
Mailing address
4278 COVENTRY GREEN CIR, DEPT OF MEDICINE, WILLIAMSVILLE, NY 14221-7237
(585) 802-1510
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007841
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02426548
—
NY
Enumeration date
06/24/2006
Last updated
01/13/2017
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