Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Jacqueline Gloria Sullivan, PA

Individual provider Physician Assistant · NPI 1104051549

Mrs. Jacqueline Gloria Sullivan, PA is a Physician Assistant in Bronx, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 2009, 17 years ago. Practices with Samaritan Medical Services PC, a 336-clinician group and accepts Medicare assignment.

Years since qualifying
17
Trained at
State University of New York at Stony Brook, School of Medicine
In the registry since
2009
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

111 E 210th St
Bronx, NY 10467-2401
Phone: (718) 920-4321
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1104051549
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 28, 2009
Last updated in NPPESMay 28, 2009

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 2009 (17 years in practice)
Group practice Samaritan Medical Services Pc — 336 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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