Healthcare Provider Details

I. General information

NPI: 1972423085
Provider Name (Legal Business Name): GABRIELLA BURLEIGH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 DIAMOND ROCK HILL RD
MALVERN PA
19355-9529
US

IV. Provider business mailing address

2050 DIAMOND ROCK HILL RD
MALVERN PA
19355-9529
US

V. Phone/Fax

Practice location:
  • Phone: 484-819-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP034531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: