Healthcare Provider Details

I. General information

NPI: 1528955648
Provider Name (Legal Business Name): SYDNEY BURSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4668 PEMBROKE BLVD STE 115
VIRGINIA BEACH VA
23455-6423
US

IV. Provider business mailing address

1425 PEARTREE ARCH
VIRGINIA BEACH VA
23453-1928
US

V. Phone/Fax

Practice location:
  • Phone: 757-648-8562
  • Fax:
Mailing address:
  • Phone: 757-918-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: