| Provider / Organization | NPI | Date Certified |
|---|---|---|
| HENSON SULLIVAN | 1831820133 | 2022-06-19 |
Henson Sullivan is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1831820133. Registration indicates Henson Sullivan is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Henson Sullivan |
| Practice Office Address | 3301 COLLEGE AVE DAVIE, FL US |
| Practice Office Telephone | 9542621101 |
| Mailing Address | 3301 COLLEGE AVE DAVIE, FL 333147796 US |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |