Individual
ANEESHA HANAN BAKIR SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11034 N 23RD DR STE 105B, PHOENIX, AZ 85029-4743
(602) 639-0189
(844) 955-2502
Mailing address
9169 W VAN BUREN ST, TOLLESON, AZ 85353-2942
(623) 233-6676
(602) 314-4579
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4842
AZ
385HR2055X
Child Mental Illness Respite Care
5471496
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
669150
—
AZ
Enumeration date
12/27/2007
Last updated
09/14/2021
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