Provider Demographics
NPI:1417067166
Name:BURNETT-SILVEIRA, PETEY DUNBAR (MED)
Entity Type:Individual
Prefix:MRS
First Name:PETEY
Middle Name:DUNBAR
Last Name:BURNETT-SILVEIRA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 W SR 434
Mailing Address - Street 2:STE 500
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-682-7900
Mailing Address - Fax:407-862-2728
Practice Address - Street 1:2989 W SR 434
Practice Address - Street 2:STE 500
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-682-7900
Practice Address - Fax:407-862-2728
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0001049OtherLMFT