Ilyssa Sultanik

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

010577 Issued in GA

Practice address

1436 Devonash LN
Atlanta, GA 30338-5525

Phone

(404) 402-4002

NPI assigned

Oct 7, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1255093290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 STEPHANIE TRL NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 DEVONASH LN",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303385525",
            "telephone_number": "404-402-4002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1751 Stephanie Trl NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303293577",
            "country_code": "US",
            "telephone_number": "404-402-4002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULTANIK",
        "first_name": "ILYSSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "010577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Sean Sullivan, M.D.
• Sarah Russell Sullivan, NP
• Shannon Oliver Sullivan, LPC, CPCS
• Michael Eric Suls, D.O., M.P.H.
• Suha Sultan
• Carmen Sulton, MD
• Jana Leigh Sulzer, M.D.
• Tulena Sumar, LCSW
• Karen Deborah Sumers, M.D.
• Andre Sumiel

• Speech-Language Pathologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.