Provider Demographics
NPI:1366825069
Name:BURT, SIERRA
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:BURT
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 1:28 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-6716
Mailing Address - Country:US
Mailing Address - Phone:845-227-6574
Mailing Address - Fax:845-227-7450
Practice Address - Street 1:19 ROSE ST
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5733
Practice Address - Country:US
Practice Address - Phone:845-227-6574
Practice Address - Fax:845-227-7450
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator