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DR. SANDRA JUDD SULLIVAN PSYD
NPI 1073851663
Psychologist - Clinical in San Mateo, CA

Active since January 16, 2013Opted out of Medicare · through Mar 20, 2028
155 BOVET RD, SUITE 404, SAN MATEO, CA 94402(650) 762-6752 Get Directions Write a Review

NPPES record last updated: January 16, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Sandra Judd Sullivan Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SANDRA JUDD SULLIVAN PSYD (NPI 1073851663) is an individual clinical provider in San Mateo, California, licensed in California (PSY20296) and active in the NPI registry since January 2013. She has opted out of Medicare through March 20, 2028.

NPPES Registry Identity

NPI1073851663
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. SANDRA JUDD SULLIVANCredential: PSYD
Location Address155 BOVET RD, SUITE 404San Mateo, CA 94402-3108
Mailing Address1140 Cambridge RdBurlingame, CA 94010-3305 · (650) 762-6752
Phone(650) 762-6752
Sole ProprietorYes
Enumeration DateJanuary 16, 2013
✔ NPI 1073851663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · PSY20296
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
155 BOVET RD, San Mateo, CA 94402
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Sandra Judd Sullivan Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 20, 2024 through March 20, 2028.

Opt-Out Effective DateMarch 20, 2024
Opt-Out In Effect ThroughMarch 20, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94402 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$202.35 typical visit price
range $69.00 – $202.35
Typical copayment $50.58 (range $17.25 – $50.58)
Most-billed visit code 99205
Established Patient
$119.48 typical visit price
range $23.44 – $166.46
Typical copayment $29.87 (range $5.86 – $41.61)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LORITA L. BANK PH.D.
Psychologist (Clinical)
155 BOVET RD, SUITE 404
SAN MATEO, CA 94402
San Mateo County (650) 212-2265
KATHLEEN M. DONOHUE PH.D.
Psychologist (Clinical)
155 BOVET RD, SUITE 404
SAN MATEO, CA 94402
San Mateo County (650) 918-0720
DR. NANCY M. MARX PH.D.
Psychologist
155 BOVET RD, SUITE 404
SAN MATEO, CA 94402
San Mateo County (650) 562-1904

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sandra Sullivan's NPI number?

The NPI number for Sandra Sullivan is 1073851663. It was assigned to this individual provider in the NPPES registry on January 16, 2013.

Where is Sandra Sullivan located?

Sandra Sullivan practices at 155 Bovet Rd Suite 404, San Mateo, CA 94402. The listed phone number is (650) 762-6752.

What is Sandra Sullivan's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Sandra Sullivan enrolled in Medicare?

No. Sandra Sullivan has opted out of Medicare through March 20, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Sandra Sullivan was last updated on January 16, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.