Individual provider Active NPI

Sandra Marie Sulik, MD

  • Family Medicine Physician
  • Fayetteville, NY
National Provider Identifier
1861414021
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
184267 Issued in NY
Practice address
4000 Medical Center Dr
Suite 104
Fayetteville, NY 13066-6635
Phone
(315) 663-0059
Fax
(315) 663-0123
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 184267 NY
Family Medicine Physician 207Q00000X 184267 NY Primary

Addresses

Primary practice location

4000 Medical Center Dr
Suite 104
Fayetteville, NY 13066-6635

Mailing address

5112 West Taft Road
Suite L
Liverpool, NY 13088
Phone (315) 452-2500

Other identifiers 1

IdentifierTypeStateIssuer
01285230MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051012000451 NY Practitioner - Family Practice 0749205367 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

4101 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 637-7878

4103 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1500

4104 Medical Ctr Dr
Suite 104
Fayetteville, NY 13066-6635
Phone (315) 663-0059

4117 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1551

5100 W Taft Rd
Liverpool, NY 13088-4841

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical PC Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
North Medical PC Family Medicine Current Accepting new patients
St Josephs Hospital Health Center CurrentSince Sep 1, 2005 Accepting new patients
OBGYN Hospitalist Medical Services of New York, P.C. Obstetrics & Gynecology CurrentSince Jul 4, 2022 Accepting new patients
St Joseph'S Hospital Health Center Family Medicine CurrentSince Sep 1, 2005 Accepting new patients
St. Joseph'S Pathology, PC Current Accepting new patients

Locations

4000 Medical Center Dr
Ste 104
Fayetteville, NY 13066
Phone (315) 637-7878

4104 Medical Center Dr
Ste 104
Fayetteville, NY 13066
Phone (315) 663-0059

5112 W Taft Rd
Ste L
Liverpool, NY 13088

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

2210 Troy Schenectady Rd
Schenectady, NY 12309
Phone (518) 346-6400

255 Lafayette Ave
Suffern, NY 10901
Phone (845) 357-7830

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

Interoperability endpoints

  • Direct secure messaging: ssulik2387666@direct.trinity-health.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1861414021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5112 WEST TAFT ROAD",
            "address_2": "SUITE L",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "13088",
            "telephone_number": "315-452-2500",
            "fax_number": "315-452-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DR",
            "address_2": "SUITE 104",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666635",
            "telephone_number": "315-663-0059",
            "fax_number": "315-663-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULIK",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-06-01",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "184267",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "184267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01285230",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.