Healthcare Provider Details

I. General information

NPI: 1467272641
Provider Name (Legal Business Name): EMMA MIRANDA BURNS LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. EMMA MIRANDA PLETT

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W ROE BLVD
PATCHOGUE NY
11772-2399
US

IV. Provider business mailing address

406 OSBORN AVE APT 3
RIVERHEAD NY
11901-3032
US

V. Phone/Fax

Practice location:
  • Phone: 631-530-1959
  • Fax:
Mailing address:
  • Phone: 631-530-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: