Provider Demographics
NPI:1740976240
Name:BURSTON, SPECIALLE
Entity type:Individual
Prefix:MS
First Name:SPECIALLE
Middle Name:
Last Name:BURSTON
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 1:1801 E 12TH ST APT 1008
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3537
Mailing Address - Country:US
Mailing Address - Phone:216-554-7258
Mailing Address - Fax:
Practice Address - Street 1:1801 E 12TH ST APT 1008
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3537
Practice Address - Country:US
Practice Address - Phone:216-554-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health