Healthcare Provider Details

I. General information

NPI: 1811692692
Provider Name (Legal Business Name): SANDRA BURKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26132 DEFOE DR
NORTH OLMSTED OH
44070-1925
US

IV. Provider business mailing address

26132 DEFOE DR
NORTH OLMSTED OH
44070-1925
US

V. Phone/Fax

Practice location:
  • Phone: 216-210-7309
  • Fax:
Mailing address:
  • Phone: 216-210-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: