Individual
SYREETA LASHAY BURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2149 WILEY OAKS LN, JACKSONVILLE, FL 32210-2692
(904) 570-6863
Mailing address
2149 WILEY OAKS LN, JACKSONVILLE, FL 32210-2692
(904) 570-6863
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
833761470
—
FL
Enumeration date
03/13/2019
Last updated
03/13/2019
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