MEDICARE: MRS. AMANDA MICHELLE BURNS CAP 100304

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ICADC.0000088	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAP0100304	FL

General Provider Information

NPI Number	:	1104507276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA MICHELLE BURNS CAP 100304

Provider Business Mailing Address
First Line	:	4043 TWINBUSH TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-7669
Country	:	US
Telephone Number	:	941-356-7488
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 DEACON PL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-2719
Country	:	US
Telephone Number	:	888-330-2532
Fax Number	:	941-283-7550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	08/01/2023

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