Healthcare Provider Details

I. General information

NPI: 1972271112
Provider Name (Legal Business Name): SHEILA BURGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

IV. Provider business mailing address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-9079
  • Fax: 407-964-1274
Mailing address:
  • Phone: 407-382-9079
  • Fax: 407-964-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: