Individual
CHASTITY MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1812 CARLETON AVE, BAY SHORE, NY 11706-1606
(631) 275-5678
Mailing address
1812 CARLETON AVE, BAY SHORE, NY 11706-1606
(631) 275-5678
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
317079
NY
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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