Individual
DR. PATRICIA SUSANA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD MPH
Contact information
Practice address
702 E BELL RD, STE 112, PHOENIX, AZ 85022-6639
(602) 826-7134
(480) 269-9462
Mailing address
14251 N 6TH PL, PHOENIX, AZ 85022-4224
(602) 882-9486
(480) 269-9462
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40062
AZ
208D00000X
General Practice Physician
15987
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159875
—
SC
01
—
2015987
CDS
SC
05
—
358212
—
AZ
01
—
F427208066
MEDICARE ID-TYPE UNSELECTED
—
Enumeration date
04/07/2006
Last updated
03/07/2023
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