Provider Demographics
NPI:1528311438
Name:SULLIVAN, DAIRA E (MSED)
Entity type:Individual
Prefix:
First Name:DAIRA
Middle Name:E
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 1:903 ALAN DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1041
Mailing Address - Country:US
Mailing Address - Phone:516-826-4253
Mailing Address - Fax:
Practice Address - Street 1:903 ALAN DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1041
Practice Address - Country:US
Practice Address - Phone:516-826-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator