Individual
MRS. MISHA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
185 QUEEN CITY AVE, MANCHESTER, NH 03101-7121
(603) 625-1655
(603) 626-4686
Mailing address
185 QUEEN CITY AVE, MANCHESTER, NH 03101-7121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0845
NH
Other
Enumeration date
02/27/2007
Last updated
09/30/2011
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