Provider Demographics
NPI:1336349935
Name:BURNETTE, SOLANGE MOYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLANGE
Middle Name:MOYA
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOLANGE
Other - Middle Name:PITARELLO
Other - Last Name:MOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40767
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0767
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:904-391-5001
Practice Address - Street 1:900 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-396-0000
Practice Address - Fax:904-396-5206
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine