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Individual

MICHAEL K SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-4242
Mailing address
17 SAYLES AVE, LINCOLN, RI 02865-2133
(401) 617-1457

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4657
CT
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
07/24/2019
Last updated
05/31/2020
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