Maureen Anne Sullivan, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2732121 Issued in NY

Practice address

105 Krystal Dr
Somers, NY 10589-3038

Phone

(914) 589-9897

NPI assigned

Nov 7, 2007

Last updated

Nov 7, 2007By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1679753610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 LIVONIA DR",
            "city": "PATTERSON",
            "state": "NY",
            "postal_code": "125638911",
            "telephone_number": "845-279-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 KRYSTAL DR",
            "city": "SOMERS",
            "state": "NY",
            "postal_code": "105893038",
            "telephone_number": "914-589-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MAUREEN",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "2732121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02587511",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Somers Physical Medicine Rehabilitation PC
• Paula Margaret Soohoo, RN
• Edward B. Sottile, MD
• Richard Arthur Stauber, DDS
• Mitchell Barry Stein, DDS
• T M Pharmacy Inc (Somers Pharmacy)
• Judith Marie Talmo, PT
• Sandra Jean Tarasevich, O.D.
• Carol Theodore, FNP
• Marc Tisch, D.D.S.

• Licensed Practical Nurse in Somers, NY
• Providers in Somers, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.