Provider Demographics
NPI:1962736330
Name:BURYE, CAROL (SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BURYE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DON FELIPE RD SW
Mailing Address - Street 2:PAJARITO ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6784
Mailing Address - Country:US
Mailing Address - Phone:505-877-9718
Mailing Address - Fax:
Practice Address - Street 1:2701 DON FELIPE RD SW
Practice Address - Street 2:PAJARITO ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6784
Practice Address - Country:US
Practice Address - Phone:505-877-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB8056Medicaid