| Doctor Name: | DAVID SULLIVAN |
| NPI Number: | 1053733253 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | JB2110 |
| Business Practice Address: | 2823 Glover Carlton Rd Perry, FL - 323487640 |
| Business Phone Number: | 8505844775 |
| Business Fax Number: | 8505844735 |
| Mailing Address: | 2823 Glover Carlton Rd, PERRY |
| State: | FL |
| Postal Code: | 323487640 |
| Phone Number: | 8505844775 |
| Fax Number: | 8505844735 |
| NPI Enumeration Date: | 01/08/2014 |
| NPI Last Update Date: | 01/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | JB2110 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |