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Individual

AMANDA KELLY SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-5110
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 724-5110

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
363AM0700X
Medical Physician Assistant
006343
CT

Other

Enumeration date
09/12/2023
Last updated
04/30/2026
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