Provider Demographics
NPI:1164919296
Name:BURBELLA, SOOANN S (AP, MD)
Entity Type:Individual
Prefix:DR
First Name:SOOANN
Middle Name:S
Last Name:BURBELLA
Suffix:
Gender:F
Credentials:AP, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6695 NW 25TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1434
Mailing Address - Country:US
Mailing Address - Phone:816-286-6118
Mailing Address - Fax:
Practice Address - Street 1:2231 NW 34TH TER
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2234
Practice Address - Country:US
Practice Address - Phone:954-600-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist