| Doctor Name: | TANYA SULLIVAN |
| NPI Number: | 1023341187 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F305149-1 |
| Business Practice Address: | One Gustave Levy Place Ny, NY - 10029 |
| Business Phone Number: | 2122415881 |
| Business Fax Number: | |
| Mailing Address: | 1400 5th Ave Apt 3h, NEW YORK |
| State: | NY |
| Postal Code: | 100262585 |
| Phone Number: | 9736504353 |
| Fax Number: | |
| NPI Enumeration Date: | 09/08/2009 |
| NPI Last Update Date: | 09/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F305149-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |