1386217412 NPI number — LATOYA (SABRINA) SABRINA BURNELL PTA19697

Table of content: MS. NICOLE SKY LINARES (NPI 1457070112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386217412 NPI number — LATOYA (SABRINA) SABRINA BURNELL PTA19697

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNELL
Provider First Name:
LATOYA (SABRINA)
Provider Middle Name:
SABRINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA19697
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386217412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33740 SKIFF ALY UNIT 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-5484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-351-3417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 COMPASS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-787-3422
Provider Business Practice Location Address Fax Number:
847-441-4130
Provider Enumeration Date:
07/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  J2-0011528 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: PTA19697 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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