Provider Demographics
NPI:1013275445
Name:BURNS, DEJUAN ANDREA
Entity Type:Individual
Prefix:MS
First Name:DEJUAN
Middle Name:ANDREA
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 1:6600 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3737 BRANCH AVE STE D14
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1405
Practice Address - Country:US
Practice Address - Phone:202-802-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 224P00000X, 332BC3200X
MD1013275445335E00000X
MDMT00729023747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No171W00000XOther Service ProvidersContractor
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No335E00000XSuppliersProsthetic/Orthotic Supplier
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457852600OtherNPI