Individual
TYLER MATTHEW SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
14 PORTER ST, EAST BOSTON, MA 02128
(617) 569-3189
Mailing address
178 CEDAR ST, WELLESLEY, MA 02481-5513
(978) 912-1967
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN2295420
MA
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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