Michael David Sullivan

Primary specialty

Social WorkerTaxonomy code 104100000X

License

087166 Issued in NY

Practice address

403 1/2 Hector St
Ithaca, NY 14850-2025

Phone

(724) 704-1719

NPI assigned

Oct 15, 2018

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556323200000",
    "number": "1366918617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 1/2 HECTOR ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148502025",
            "telephone_number": "724-704-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 1/2 HECTOR ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148502025",
            "telephone_number": "724-704-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-15",
        "last_updated": "2019-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "087166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant E Sullivan, RPH
• Joan M Sullivan, MD
• Kristine Sullivan, NP
• Laura Sullivan, LCSW, CASAC
• Lindsey Sullivan, PA-C
• Michele L Summers, FNP
• Summit Alternatives LMSW PC
• Meera E Sundaram, PT, DPT
• Alecia Sundsmo, PSY.D.
• William Supplee, MD

• Social Worker in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2019; 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.