Individual
LORRAINE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1747 VETERANS HWY STE 24, ISLANDIA, NY 11749-1534
(631) 853-7300
(631) 853-7301
Mailing address
756 BLUE RIDGE DR, MEDFORD, NY 11763-1209
(516) 810-0475
(631) 732-6592
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
F400014
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400014
NY
Other
Enumeration date
09/21/2006
Last updated
04/17/2023
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