Individual provider Active NPI

Kelly Sullivan

  • Speech-Language Pathologist
  • Garden City, NY
National Provider Identifier
1508597717
Registry record updated Jun 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
300 Garden City PLZ Ste 350
Garden City, NY 11530-3358
Phone
(516) 747-9030
NPI assigned
Jun 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

300 Garden City PLZ Ste 350
Garden City, NY 11530-3358

Mailing address

300 Garden City PLZ Ste 350
Garden City, NY 11530-3358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1655596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655596800000",
    "number": "1508597717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 GARDEN CITY PLZ STE 350",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115303358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GARDEN CITY PLZ STE 350",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115303358",
            "telephone_number": "516-747-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-19",
        "last_updated": "2022-06-19",
        "certification_date": "2022-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2022; 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.