Provider Demographics
NPI:1619581972
Name:BURNS, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BURNS
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 1:18622 OPESSA ST
Mailing Address - Street 2:
Mailing Address - City:OLDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21555
Mailing Address - Country:US
Mailing Address - Phone:240-727-9760
Mailing Address - Fax:
Practice Address - Street 1:18622 OPESSA ST
Practice Address - Street 2:
Practice Address - City:OLDTOWN
Practice Address - State:MD
Practice Address - Zip Code:21555
Practice Address - Country:US
Practice Address - Phone:240-727-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator