Individual
VICTORIA LUCILLE MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CPT
Contact information
Practice address
250 E MAIN ST, BAY SHORE, NY 11706-8442
(631) 390-7100
(631) 390-7128
Mailing address
250 E MAIN ST, BAY SHORE, NY 11706-8442
(631) 390-7100
(631) 390-7128
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86066679
NY
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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