Provider Demographics
NPI:1699655498
Name:SULLIVAN, BENJAMIN DEVLIN (PA-S)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DEVLIN
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3322
Mailing Address - Country:US
Mailing Address - Phone:615-804-0009
Mailing Address - Fax:
Practice Address - Street 1:400 GOODYS LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1914
Practice Address - Country:US
Practice Address - Phone:865-251-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program