Amy Sullivan

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2660 Issued in TN

Practice address

811 Keylon St
Manchester, TN 37355-2413

Phone

(931) 450-5150

NPI assigned

Oct 29, 2019

Last updated

Oct 29, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Broad River Rehabilitation

  dba Broad River Rehab

  • Occupational Therapist
  • Charlotte, NC
  • NPI 1902317589

  Speech-Language Pathologist, TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1396389813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 KEYLON ST",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 KEYLON ST",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552413",
            "telephone_number": "931-450-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "AMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-29",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "2660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2660",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "na",
            "affiliation": "N",
            "endpointDescription": "na",
            "address_1": "811 Keylon St",
            "city": "Manchester",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373552413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Staffco of Eastern TN. Inc (At Home Health Care of Central Tn.)
• State of Tennessee (Coffee County Health Department)
• Zsarel Stepp
• Brooke Stokes
• Isaac H Stovall, M D
• Suncrest Companion Services, LLC (SunCrest Companion Services of Manchester)
• Suncrest Home Health of Manchester, Inc. (Beacon Home Health)
• Mark B Superstein, D.P.M.
• Gretchen Ann Sussen, PTA
• Leif Sven Swanson, D.D.S

• Speech-Language Pathologist in Manchester, TN
• Providers in Manchester, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.