Healthcare Provider Details

I. General information

NPI: 1710931183
Provider Name (Legal Business Name): JULIET DANA BURRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E CENTRAL PKWY SUITE 115
ALTAMONTE SPRINGS FL
32701-3402
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-5115
  • Fax: 407-671-5116
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME85974
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME85974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: