Provider Demographics
NPI:1437203999
Name:SULLIVAN, MARIA A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 WALDO AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3000
Mailing Address - Country:US
Mailing Address - Phone:718-548-1661
Mailing Address - Fax:212-543-6018
Practice Address - Street 1:140 RIVERSIDE DR # 1- O
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2605
Practice Address - Country:US
Practice Address - Phone:212-678-9508
Practice Address - Fax:212-543-6018
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1942882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45M231Medicare ID - Type Unspecified