Provider Demographics
NPI:1629429519
Name:BURGESS, ALEXANDRA MORENA (AUD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MORENA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N MAIN STREET EXT STE 1C
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2487
Mailing Address - Country:US
Mailing Address - Phone:203-741-9943
Mailing Address - Fax:203-741-9167
Practice Address - Street 1:415 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2557
Practice Address - Country:US
Practice Address - Phone:203-272-4512
Practice Address - Fax:203-272-4517
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001863231H00000X
NY002708231H00000X
NY14000051304237600000X
CT742231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter