AMANDA ROSE SULLIVAN PMHNP-BC NPI 1063968709

NPI Information

  • NPI: 1063968709
  • Provider Name: AMANDA ROSE SULLIVAN, PMHNP-BC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 86 BAKER AVE EXTENSION
    SUITE 100
    CONCORD, MA
    ZIP 01742
  • Phone: (978) 369-1113

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NPI Details

Amanda Rose Sullivan, PMHNP-BC is a psychiatric/mental health nurse practitioner in Concord, MA. Amanda Rose Sullivan, PMHNP-BC NPI is 1063968709. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

86 BAKER AVE EXTENSION
SUITE 100
CONCORD, MA
ZIP 01742
Phone: (978) 369-1113

The NPI 1063968709 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 9/1/2016 and was last updated on 9/1/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental HealthRN2262691MASSACHUSETTSYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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