Provider Demographics
NPI:1538125653
Name:BURRUS, MEREDITH (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:BURRUS
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 1:6401 SW 87TH AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2500
Mailing Address - Country:US
Mailing Address - Phone:305-793-8257
Mailing Address - Fax:305-675-9200
Practice Address - Street 1:6401 SW 87TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2500
Practice Address - Country:US
Practice Address - Phone:305-793-8257
Practice Address - Fax:305-675-9200
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3686103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592788627Medicare UPIN