Stacy Sullivan, MA,CCC/LSP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0065631 Issued in NY

Practice address

235 Jackson Crescent
Centerport, NY 11721

Phone

(631) 424-8972

NPI assigned

Oct 14, 2010

Last updated

Oct 14, 2010By the provider in NPPES

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

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1497065213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 JACKSON CRES",
            "city": "CENTERPORT",
            "state": "NY",
            "postal_code": "117211054",
            "telephone_number": "631-424-8972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 JACKSON CRESCENT",
            "city": "CENTERPORT",
            "state": "NY",
            "postal_code": "11721",
            "telephone_number": "631-424-8972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STACY",
        "name_prefix": "Ms.",
        "credential": "MA,CCC/LSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-14",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "0065631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Ann Smith, LMT
• Christopher Smith
• Dina Smith, LCSW
• Catherine P. Stratton, REGISTERED DIETITIAN
• Donald Sturz
• Sunita M. Makhijani Physician PLLC
• Katherine Mary Terry, M.S., CCC-SLP
• Imelda Bangcong Torayno
• Naomi Ulrich, MA
• Monica Teresa Wilda Valville-Quintero, LMHC

• Speech-Language Pathologist in Centerport, NY
• Providers in Centerport, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.