Individual
JOHANNA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
370 BASSETT RD, NORTH HAVEN, CT 06473-4201
(917) 435-0238
Mailing address
370 BASSETT RD, NORTH HAVEN, CT 06473-4201
(917) 435-0238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/20/2022
Last updated
04/28/2023
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