Provider Demographics
NPI:1033506951
Name:SULLIVAN-BUZZARD, VICTORIA (IBCLC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SULLIVAN-BUZZARD
Suffix:
Gender:
Credentials:IBCLC
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:BUZZARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:605 ROSETO AVE
Mailing Address - Street 2:
Mailing Address - City:ROSETO
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1105
Mailing Address - Country:US
Mailing Address - Phone:917-742-2659
Mailing Address - Fax:
Practice Address - Street 1:605 ROSETO AVE
Practice Address - Street 2:
Practice Address - City:ROSETO
Practice Address - State:PA
Practice Address - Zip Code:18013-1105
Practice Address - Country:US
Practice Address - Phone:917-742-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11111419174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN