Provider Demographics
NPI:1639137169
Name:SULLIVAN, TORY (MD)
Entity type:Individual
Prefix:DR
First Name:TORY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 NE 16TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4708
Mailing Address - Country:US
Mailing Address - Phone:305-652-8600
Mailing Address - Fax:305-652-3139
Practice Address - Street 1:16100 NE 16TH AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4708
Practice Address - Country:US
Practice Address - Phone:305-652-8600
Practice Address - Fax:305-652-3139
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME811312083B0002X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267268500Medicaid
FL79839EMedicare ID - Type Unspecified
FLH97402Medicare UPIN
FL79839XMedicare PIN