Individual
WILSON MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1535 GREENE AVE APT 2L, BROOKLYN, NY 11237-6912
(917) 676-2347
Mailing address
1535 GREENE AVE APT 2L, BROOKLYN, NY 11237-6912
(917) 676-2347
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
407245
NY
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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