Active NPI
Keri Sullivan
- Behavior Analyst
- Lake Mary, FL
National Provider Identifier
1578948295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 11518907
- Practice address
- 175 Middle St
Suite 1201
Lake Mary, FL 32746-3625 - Phone
- (315) 447-3617
- NPI assigned
- Jul 23, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 11518907 | NC | Primary |
Addresses
Primary practice location
175 Middle St
Suite 1201
Lake Mary, FL 32746-3625
Mailing address
8303 Spotter Dr
Apex, NC 27502-2458
Phone (315) 447-3617
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009093700 | Medicaid | FL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11518907 | NC | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490313600000",
"number": "1578948295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8303 SPOTTER DR",
"city": "APEX",
"state": "NC",
"postal_code": "275022458",
"telephone_number": "315-447-3617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 MIDDLE ST",
"address_2": "SUITE 1201",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463625",
"telephone_number": "315-447-3617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KERI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-23",
"last_updated": "2017-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NC",
"license": "11518907",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009093700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.