Provider Demographics
NPI:1184037244
Name:BURLEY, BRANDEE LEE
Entity Type:Individual
Prefix:MS
First Name:BRANDEE
Middle Name:LEE
Last Name:BURLEY
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 1:821 PRE EMPTION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:315-787-5310
Mailing Address - Fax:315-787-5315
Practice Address - Street 1:821 PRE EMPTION RD STE 300
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-787-5310
Practice Address - Fax:315-787-5315
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant