Individual
KENDRA LASONIA MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
80 SEYMOUR ST, HARTFORD HOSPITAL SURGERY DEPT - CRITICAL CARE, HARTFORD, CT 06102-8000
(860) 545-4670
Mailing address
PO BOX 415933, HARTFORD HOSPITAL PROFESSSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001495
CT
363AM0700X
Medical Physician Assistant
001495
CT
363AS0400X
Surgical Physician Assistant
Primary
001495
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003014958
—
CT
Enumeration date
10/18/2006
Last updated
05/06/2013
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