Provider Demographics
NPI:1053601971
Name:SULLIVAN-PYKE, CHANTAE (MD, MTR)
Entity type:Individual
Prefix:DR
First Name:CHANTAE
Middle Name:
Last Name:SULLIVAN-PYKE
Suffix:
Gender:F
Credentials:MD, MTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COMMACK RD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5022
Mailing Address - Country:US
Mailing Address - Phone:631-638-4600
Mailing Address - Fax:631-520-2561
Practice Address - Street 1:500 COMMACK RD UNIT 202
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5022
Practice Address - Country:US
Practice Address - Phone:631-638-4600
Practice Address - Fax:631-520-2561
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272837207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology