Individual
MARY ANNE MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
931 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1228
(631) 331-7200
Mailing address
7 ELM ST, CENTRAL ISLIP, NY 11722-4111
(631) 232-1572
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F304650
NY
Other
Enumeration date
08/14/2007
Last updated
01/13/2014
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