Healthcare Provider Details

I. General information

NPI: 1407808744
Provider Name (Legal Business Name): EILEEN MARY BURCHBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH AVE E STE 2
BRADENTON FL
34208-1043
US

IV. Provider business mailing address

4912 20TH AVE W
BRADENTON FL
34209-5702
US

V. Phone/Fax

Practice location:
  • Phone: 941-226-0018
  • Fax: 941-260-4872
Mailing address:
  • Phone: 516-233-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38674
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberME148372
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number148372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: