Provider Demographics
NPI:1861414021
Name:SULIK, SANDRA MARIE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:SULIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 WEST TAFT ROAD
Mailing Address - Street 2:SUITE L
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-2500
Mailing Address - Fax:315-452-2510
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6635
Practice Address - Country:US
Practice Address - Phone:315-663-0059
Practice Address - Fax:315-663-0123
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184267207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01285230Medicaid
NYRA8216Medicare ID - Type Unspecified7694-6
NY01285230Medicaid
NYP00368252Medicare PIN
NY58564HMedicare PIN
NYRA8216Medicare PIN
NY080104353Medicare PIN