Provider Demographics
NPI:1447546817
Name:BURNETTE, SANDRA E (MA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9804
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-0804
Mailing Address - Country:US
Mailing Address - Phone:336-294-8091
Mailing Address - Fax:336-294-8432
Practice Address - Street 1:3201 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1455
Practice Address - Country:US
Practice Address - Phone:336-294-8091
Practice Address - Fax:336-294-8432
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist