Provider Demographics
NPI:1669590808
Name:BURRIS, SHERYL ELAINE (ATC)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ELAINE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 JOHN ROWLAND TRL
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3548
Mailing Address - Country:US
Mailing Address - Phone:302-644-0394
Mailing Address - Fax:
Practice Address - Street 1:16423 JOHN ROWLAND TRL
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3548
Practice Address - Country:US
Practice Address - Phone:302-644-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00001262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer