Timothy S. Sullivan, PH.D,, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

5645 Issued in OH

Legal business name

TIMOTHY S. SULLIVAN, PH.D,, LLC

Practice address

3869 Darrow Rd
Suite 104
Stow, OH 44224-2691

Phone

(713) 820-4208

NPI assigned

Apr 1, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Timothy S Sullivan, PH.D

Title

Physician

Phone

(713) 820-4208

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427846400000",
    "number": "1730574237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3869 DARROW RD",
            "address_2": "SUITE 104",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442242691",
            "telephone_number": "713-820-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3869 DARROW RD",
            "address_2": "SUITE 104",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442242691",
            "telephone_number": "713-820-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY S. SULLIVAN, PH.D,, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-01",
        "last_updated": "2015-04-01",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "713-820-4208",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "OH",
            "license": "5645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Stow, OH
• Providers in Stow, OH by specialty
• Clinical Neuropsychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; 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.