Provider Demographics
NPI:1801870688
Name:BURRAS, PETER SHANE (LAC,)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:SHANE
Last Name:BURRAS
Suffix:
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAPLE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4956
Mailing Address - Country:US
Mailing Address - Phone:802-347-1834
Mailing Address - Fax:
Practice Address - Street 1:47 MAPLE ST STE 214
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4956
Practice Address - Country:US
Practice Address - Phone:802-347-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8977171100000X
VT091.0059682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist