MRS. JACQUELINE GLORIA SULLIVAN (NPI# 1104051549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104051549 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELINE GLORIA SULLIVAN |
| Credential | PA |
| Practice Address |
111 E 210th St Bronx NY 10467-2401 |
| Mailing Address |
232 Springmeadow Dr Unit C Holbrook NY 11741-4137 |
| Practice Telephone | 7189204321 |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2009-05-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942663406 | Jacqueline Sullivan | Behavioral Analyst | 1127 Autumn Point Ct, Jacksonville, FL 32218-9030 | 2016-04-01 |
| 1689086704 | Jacqueline Sullivan | Psychologist | 344 Mary St, Downingtown, PA 19335-2518 | 2014-05-22 |
| 1245337435 | Jacqueline A Sullivan | Social Worker | 417 Highland Avenue, Suite 1, Waterbury, CT 06708 | 2006-09-20 |
| 1396201687 | Jacqueline Marie Sullivan | Social Worker | 709 5th Ave W, Hendersonville, NC 28739-4101 | 2019-02-12 |
| 1659829786 | Jacqueline S Sullivan | Physician Assistant | 301 E Main St, Bay Shore, NY 11706-8408 | 2016-09-19 |
| 1124451547 | Jacqueline Florentino Sullivan | Chiropractor | 920 W Indiantown Rd, Suite 107, Jupiter, FL 33458-6847 | 2013-08-21 |
| 1215277736 | Jacqueline B. Sullivan | Social Worker | 384 Washington St, Norwell, MA 02061-2010 | 2013-02-20 |
| 1679847107 | Jacqueline Yvonne Sullivan | Advanced Practice Midwife | 601 E Main St, Waynesboro, PA 17268-2332 | 2012-03-01 |
| 1023393253 | Jacqueline Sullivan | Behavioral Analyst | 6 Southside Rd, Danvers, MA 01923-1409 | 2011-10-19 |
| 1740511104 | Jacqueline Mary Sullivan | Dietitian, Registered | W3985 County Road Nn, Elkhorn, WI 53121-4337 | 2010-01-26 |
| Street Address |
111 E 210TH ST |
| City | BRONX |
| State | NY |
| Zip Code | 10467-2401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083619373 | Caletha Dicks | Nurse Anesthetist, Certified Registered | 111 E 210th St, Bronx, NY 10467-2401 | 2005-06-14 |
| 1124629118 | Ali Liakat | Pharmacist | 111 E 210th St, Bronx, NY 10467-2401 | 2020-11-05 |
| 1225639347 | Michael Boadu | Pharmacist | 111 E 210th St, Bronx, NY 10467-2401 | 2020-11-04 |
| 1770183501 | Michelle Marsalisi | Physician Assistant | 111 E 210th St, Bronx, NY 10467-2401 | 2020-10-30 |
| 1598364606 | Denise Sarah Dailey | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-10-20 |
| 1619574167 | Amina Khan | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-10-07 |
| 1043817679 | Farzaneh Hosein Khezri | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-10-06 |
| 1366049330 | Shafaq Zaman Tarar | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-10-02 |
| 1972110450 | Assi Milwidsky | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-09-28 |
| 1518574243 | Sudhakar Basetty | Student in an Organized Health Care Education/Training Program | 111 E 210th St, Bronx, NY 10467-2401 | 2020-09-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535505 | Maxwell Ennist | Massage Therapist | 210 Bedford Park Blvd, Bronx, NY 10467 | 2020-10-09 |
| 1144854431 | Ny Metro Dental, PC | Dentist | 55 Mosholu Parkway North, Bronx, NY 10467 | 2020-02-26 |
| 1386277960 | Rhonda Ellen Nayberg | Occupational Therapist | Montefiore Medical Center Occupational Therapy Dept, 111 E 210 Street Ground Floor Blue Zone, Bronx, NY 10467 | 2020-02-21 |
| 1013568153 | Jaime Luis Betancourt | Nurse Practitioner | Sickle Cell Clinic, 3400 Bainbridge Avenue, Bronx, NY 10467 | 2019-09-20 |
| 1023662616 | Bronx Jewish Community Council Home Attendant Services | Home Health | 2930 Wallace Ave., Bronx, NY 10467 | 2019-07-31 |
| 1831755321 | Felix Medrano | Taxi | 3106 Webster Ave, Bronx, NY 10467 | 2019-05-10 |
| 1700363108 | Danaies Guzman | Occupational Therapist | 2410 Barker Avenue Apt 11a, Bronx, New York, NY 10467 | 2018-07-27 |
| 1538672175 | Carolina Duque-toro | Speech-Language Pathologist | 4251, 341 E 207th St, Bronx, NY 10467 | 2017-11-06 |
| 1255853727 | Jessica Perkiss | Social Worker | 750 Tilden St., Astor Services for Children and Families, Bronx, NY 10467 | 2017-07-17 |
| 1386166221 | Erica Santos | Licensed Practical Nurse | 3273 Parkside Place, Apt 5g, Bronx, NY 10467 | 2017-07-12 |
| Find all providers in zip 10467 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982242319 | Leonard Ohene Takyi | Physician Assistant | 4180 Hutchinson River Pkwy E Apt 8c, Bronx, NY 10475-4826 | 2019-12-16 |
| 1669018032 | Natasha Kodua | Physician Assistant | 140 Asch Loop Apt 9e, Bronx, NY 10475-4040 | 2019-11-20 |
| 1073158010 | Abdoulaye Diallo | Physician Assistant | 1223 Tinton Ave Fl 3, Bronx, NY 10456-3673 | 2019-11-13 |
| 1538703954 | Frank Owusu | Physician Assistant | 500 E 165th St Apt 2e, Bronx, NY 10456-6658 | 2019-10-29 |
| 1629534649 | David A Rivera | Physician Assistant | 2105 Cruger Ave Apt 3g, Bronx, NY 10462-2363 | 2019-02-14 |
| 1679037980 | Ryan Patrick Garrow | Physician Assistant | 1200 Waters Pl Ste M108, Bronx, NY 10461-0367 | 2019-01-31 |
| 1336603331 | Joseph A Sanchez | Physician Assistant | 6 Ploughmans Bush, Bronx, NY 10471-3541 | 2019-01-24 |
| 1639651581 | Aaron Sosa | Physician Assistant | Tower 1, 1250 Waters Pl 11th Fl, Bronx, NY 10461 | 2018-09-06 |
| 1275032542 | Ahmed Mahir | Physician Assistant | 32 Westchester Sq, Bronx, NY 10461-3514 | 2018-02-01 |
| 1730601113 | Alexandra Taylor Martin | Physician Assistant | 661 King Avenue, Bronx, NY 10464 | 2017-07-07 |
| Find all providers in BRONX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.