Active NPI
Sandra Judd Sullivan, PSYD
- Clinical Psychologist
- San Mateo, CA
National Provider Identifier
1073851663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20296
- Practice address
- 155 Bovet Rd
Suite 404
San Mateo, CA 94402-3108 - Phone
- (650) 762-6752
- NPI assigned
- Jan 16, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY20296 | CA | Primary |
Addresses
Primary practice location
155 Bovet Rd
Suite 404
San Mateo, CA 94402-3108
Mailing address
1140 Cambridge Rd
Burlingame, CA 94010-3305
Phone (650) 762-6752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 20, 2024 through Mar 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20296 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1073851663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 CAMBRIDGE RD",
"city": "BURLINGAME",
"state": "CA",
"postal_code": "940103305",
"telephone_number": "650-762-6752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 BOVET RD",
"address_2": "SUITE 404",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944023108",
"telephone_number": "650-762-6752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SANDRA",
"middle_name": "JUDD",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-16",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.