Jessica Sullivan

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

4813 Bristol Bay Way Apt 302
Tampa, FL 33619-3662

Phone

(813) 562-8475

NPI assigned

Jul 28, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1891421186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4813 BRISTOL BAY WAY APT 302",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336193662",
            "telephone_number": "813-562-8475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4813 BRISTOL BAY WAY APT 302",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336193662",
            "telephone_number": "813-562-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Sullivan, MD
• Danielle Sullivan, MT104780
• Emma Sullivan, M.S., CF-SLP
• Gregory Allen Sullivan, M.D.
• Janet Sullivan, CCCA
• Jillian Sullivan
• Johanna Lydia Sullivan, PHARM.D.
• Kaitlin Rose Sullivan, BCABA
• Katelyn Sullivan
• Keesha Monaie Sullivan, LCSW

• Developmental Disabilities Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.