Provider Demographics
NPI:1003889015
Name:BURTON, MARY J (AU D)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BURTON
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2126
Mailing Address - Country:US
Mailing Address - Phone:727-289-1212
Mailing Address - Fax:727-289-9901
Practice Address - Street 1:502 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2126
Practice Address - Country:US
Practice Address - Phone:727-289-1212
Practice Address - Fax:727-289-9901
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0451231H00000X
KY0923237700000X
FLAY1803231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000381573OtherANTHEM
IN200533170OtherMEDICAID
KYP00436413OtherMEDICARE RAILROAD
IN200533170OtherMEDICAID
KY0685505Medicare ID - Type Unspecified