Healthcare Provider Details

I. General information

NPI: 1215660188
Provider Name (Legal Business Name): AMANDA LANDRY BURKENSTOCK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BARATARIA BLVD STE 3100
MARRERO LA
70072-3083
US

IV. Provider business mailing address

1151 BARATARIA BLVD STE 3100
MARRERO LA
70072-3083
US

V. Phone/Fax

Practice location:
  • Phone: 504-934-8468
  • Fax: 504-371-3811
Mailing address:
  • Phone: 504-934-8468
  • Fax: 504-371-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6733
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: