Healthcare Provider Details

I. General information

NPI: 1598281602
Provider Name (Legal Business Name): EMILY BURAKIEWICZ AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 300
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3103
  • Fax: 508-368-3104
Mailing address:
  • Phone: 508-368-3103
  • Fax: 508-368-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4716
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: