Provider Demographics
NPI:1205648672
Name:SULLIVAN, KERI (PHD STUDENT)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WESTGATE DR APT 207
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6434
Mailing Address - Country:US
Mailing Address - Phone:339-223-6660
Mailing Address - Fax:
Practice Address - Street 1:100 MERRIMACK ST STE 201
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1707
Practice Address - Country:US
Practice Address - Phone:978-455-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program