Healthcare Provider Details

I. General information

NPI: 1922595990
Provider Name (Legal Business Name): CONNOR BURNSIDE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST STE 5000
ORLANDO FL
32804-5525
US

IV. Provider business mailing address

265 E ROLLINS ST STE 5000
ORLANDO FL
32804-5525
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3586
  • Fax: 407-821-3587
Mailing address:
  • Phone: 407-821-3586
  • Fax: 407-821-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberOS18828
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS18828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: