MS. STEPHANIE M. SULLIVAN MSN NP NPI 1730121864

NPI Information

  • NPI: 1730121864
  • Provider Name: MS. STEPHANIE M. SULLIVAN, MSN, NP
  • Classification: Nurse Practitioner - 363LX0001X
  • Specialization: Obstetrics & Gynecology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2001 DWIGHT WAY
    SECOND FLOOR
    BERKELEY, CA
    ZIP 94704
  • Phone: (510) 204-5770

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NPI Details

MS. Stephanie M. Sullivan, MSN, NP is an obstetrics and gynecology nurse practitioner in Berkeley, CA with 25 years of experience. MS. Stephanie M. Sullivan, MSN, NP NPI is 1730121864. 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:

2001 DWIGHT WAY
SECOND FLOOR
BERKELEY, CA
ZIP 94704-608
Phone: (510) 204-5770
Fax: (510) 204-5749

The NPI 1730121864 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/12/2006 and was last updated on 1/11/2022.

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
1363LX0001XNurse PractitionerObstetrics & Gynecology566514CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1005665140MEDICAIDCALIFORNIA

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: 11/21/2025

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