Kelly Sullivan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

002446 Issued in CT

Practice address

275 George St
Bridgeport, CT 06604-3320

Phone

(203) 576-8462

NPI assigned

Feb 28, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• City of Bridgeport Health Dept. School Based Health Centers

  • Health Service Clinic/Center
  • Bridgeport, CT
  • NPI 1881713246
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204156800000",
    "number": "1154590651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 FOX RUN",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068971110",
            "telephone_number": "203-576-8461",
            "fax_number": "203-332-5641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 GEORGE ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066043320",
            "telephone_number": "203-576-8462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "002446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "002446",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luis Cesar Suarez-Rodriguez, M.D.
• Loretta Suarez, CRNA
• Stephanie Sudikoff, MD
• Sufficient Mobile Labs
• Mahima Sukumar, MD
• Michael John Sullivan, AGACNP
• Summit Women'S Center Inc
• Divya Sundarapandiyan, MD
• Bujji B Surapaneni, MD
• Surgical Associates of Connecticut

• Family Nurse Practitioner in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.