Provider Demographics
NPI:1679601777
Name:SCULLEY, PATRICIA SUE (MS, CGC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:SCULLEY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:SCULLEY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:3400 COMPUTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1771
Mailing Address - Country:US
Mailing Address - Phone:210-481-6886
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 1250
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-351-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96218170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS