Healthcare Provider Details

I. General information

NPI: 1205196961
Provider Name (Legal Business Name): DANIELA M BURCHHARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 3RD AVE S STE 201
NAPLES FL
34102-6498
US

IV. Provider business mailing address

2235 VENETIAN COURT SUITE 1
NAPLES FL
34109-8728
US

V. Phone/Fax

Practice location:
  • Phone: 239-307-4605
  • Fax:
Mailing address:
  • Phone: 239-596-9337
  • Fax: 239-596-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME160142
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberR7401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: