Healthcare Provider Details

I. General information

NPI: 1457198582
Provider Name (Legal Business Name): STEVEN BURROUGHS RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CENTRAL FLORIDA BLVD
ORLANDO FL
32816-8005
US

IV. Provider business mailing address

911 N ORANGE AVE APT 332
ORLANDO FL
32801-1069
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2000
  • Fax:
Mailing address:
  • Phone: 954-651-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: