Provider Demographics
NPI:1053660779
Name:BURKETT, ANN-MARSHA
Entity Type:Individual
Prefix:
First Name:ANN-MARSHA
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21229 HILLSIDE AVE
Mailing Address - Street 2:APT 6HW
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1803
Mailing Address - Country:US
Mailing Address - Phone:646-730-2586
Mailing Address - Fax:
Practice Address - Street 1:295 CENTRAL PARK W
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3008
Practice Address - Country:US
Practice Address - Phone:718-578-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist