MEDICARE: MRS. EMMA MIRANDA BURNS LAT, ATC

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	2255A2300X	Athletic Trainer		NY

General Provider Information

NPI Number	:	1467272641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA MIRANDA BURNS LAT, ATC

Provider Business Mailing Address
First Line	:	406 OSBORN AVE APT C
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-3032
Country	:	US
Telephone Number	:	631-530-1959
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 OSBORN AVE APT C
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-3032
Country	:	US
Telephone Number	:	631-530-1959
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	05/24/2026

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