Individual
ELY MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
95 FRANK B MURRAY ST, SPRINGFIELD, MA 01103-1106
(413) 285-8586
Mailing address
95 FRANK B MURRAY ST, SPRINGFIELD, MA 01103-1106
(413) 285-8586
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/27/2018
Last updated
04/27/2018
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