Active NPI
Maureen Sullivan
- Registered Nurse
- Lic, NY
National Provider Identifier
1033411632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 487406
- Practice address
- 28-11 Queens Plaza
Lic, NY 11101 - Phone
- (718) 391-8116
- NPI assigned
- Dec 2, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 487406 | NY | Primary |
Addresses
Primary practice location
28-11 Queens Plaza
Lic, NY 11101
Mailing address
31 Pearson St
Staten Island, NY 10314
Phone (347) 350-1259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 487406 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1033411632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 PEARSON ST",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10314",
"telephone_number": "347-350-1259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28-11 QUEENS PLAZA",
"city": "LIC",
"state": "NY",
"postal_code": "11101",
"telephone_number": "718-391-8116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MAUREEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-02",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "487406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lic, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.