Provider Demographics
NPI:1063825065
Name:BURNETT, SHERILYN POWELL (MA)
Entity type:Individual
Prefix:
First Name:SHERILYN
Middle Name:POWELL
Last Name:BURNETT
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 1:19 SHERMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1213
Mailing Address - Country:US
Mailing Address - Phone:908-963-2037
Mailing Address - Fax:
Practice Address - Street 1:19 SHERMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1213
Practice Address - Country:US
Practice Address - Phone:908-963-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist