Provider Demographics
NPI:1326223389
Name:BURGESS-BELFON, JEANEL MICHELLE
Entity Type:Individual
Prefix:
First Name:JEANEL
Middle Name:MICHELLE
Last Name:BURGESS-BELFON
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 1:525 E 28TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1433
Mailing Address - Country:US
Mailing Address - Phone:347-529-0302
Mailing Address - Fax:
Practice Address - Street 1:525 E 28TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1433
Practice Address - Country:US
Practice Address - Phone:347-529-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist