Individual
MICHAEL L SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1540 S TAMIAMI TRL, SUITE 303, SARASOTA, FL 34239-2930
(941) 917-8791
(941) 917-8793
Mailing address
PO BOX 863407, ORLANDO, FL 32886-3407
(941) 917-2600
(941) 917-7884
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154PA
—
SC
05
—
261645900
—
FL
01
—
Y00N0
BCBS
FL
Enumeration date
07/12/2006
Last updated
04/04/2016
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