Provider Demographics
NPI:1356619258
Name:SULLIVAN, DEBORAH CANFIELD (MSED)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:CANFIELD
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1817
Mailing Address - Country:US
Mailing Address - Phone:585-325-7828
Mailing Address - Fax:
Practice Address - Street 1:485 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1817
Practice Address - Country:US
Practice Address - Phone:585-325-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002958-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist