1811307150 NPI number — MRS. AUBREY ROSS OBRADOVICH SULLIVAN M. ED

Table of content: MRS. AUBREY ROSS OBRADOVICH SULLIVAN M. ED (NPI 1811307150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811307150 NPI number — MRS. AUBREY ROSS OBRADOVICH SULLIVAN M. ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
AUBREY
Provider Middle Name:
ROSS OBRADOVICH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M. ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811307150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1169 EASTERN PKWY STE 3364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-813-8280
Provider Business Mailing Address Fax Number:
502-473-1334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1169 EASTERN PKWY
Provider Second Line Business Practice Location Address:
SUITE 3364
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-813-8280
Provider Business Practice Location Address Fax Number:
502-473-1334
Provider Enumeration Date:
05/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  127353 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: KY-1738 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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