| Doctor Name: | JAMES ROBERT SULLIVAN |
| NPI Number: | 1588091193 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN |
| License Number: | 5560 |
| Business Practice Address: | 100 Grand St New Britain, CT - 060522016 |
| Business Phone Number: | 8602245011 |
| Business Fax Number: | |
| Mailing Address: | 11 Blue Orchard Dr, MIDDLETOWN |
| State: | CT |
| Postal Code: | 064575006 |
| Phone Number: | 2036719271 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2013 |
| NPI Last Update Date: | 09/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 5560 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |