Healthcare Provider Details

I. General information

NPI: 1225198526
Provider Name (Legal Business Name): MRS. LEE ANNE BURNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 3RD ST N STE D
ST PETERSBURG FL
33703-6123
US

IV. Provider business mailing address

4961 104TH WAY N
ST PETERSBURG FL
33708-3301
US

V. Phone/Fax

Practice location:
  • Phone: 727-896-8086
  • Fax: 727-896-1017
Mailing address:
  • Phone: 727-397-6228
  • Fax: 727-319-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 4622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: