Provider Demographics
NPI:1497936280
Name:BURNS, SIGNE RAE (BS)
Entity Type:Individual
Prefix:
First Name:SIGNE
Middle Name:RAE
Last Name:BURNS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 ROSALIA DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-3589
Mailing Address - Country:US
Mailing Address - Phone:407-322-7166
Mailing Address - Fax:407-322-7166
Practice Address - Street 1:472 ROSALIA DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3589
Practice Address - Country:US
Practice Address - Phone:407-322-7166
Practice Address - Fax:407-322-7166
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor