Provider Demographics
NPI:1396227690
Name:BURE-REYES, ANNELLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNELLY
Middle Name:
Last Name:BURE-REYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 14TH ST STE 604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2117
Mailing Address - Country:US
Mailing Address - Phone:305-243-7529
Mailing Address - Fax:305-243-7218
Practice Address - Street 1:1150 NW 14TH ST STE 604
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2117
Practice Address - Country:US
Practice Address - Phone:930-243-7529
Practice Address - Fax:305-243-7218
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10255103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist