Provider Demographics
NPI:1730629957
Name:MIRANDA, MYRNA I
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:I
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 BRYCE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-1714
Mailing Address - Country:US
Mailing Address - Phone:787-922-0049
Mailing Address - Fax:
Practice Address - Street 1:5419 BRYCE CANYON DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-1714
Practice Address - Country:US
Practice Address - Phone:787-922-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health