Provider Demographics
NPI:1144563586
Name:MIRANDA, SANDRA ISABEL
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ISABEL
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 1:432 LOS ALTOS WAY
Mailing Address - Street 2:APT 202
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3280
Mailing Address - Country:US
Mailing Address - Phone:407-921-5178
Mailing Address - Fax:
Practice Address - Street 1:432 LOS ALTOS WAY
Practice Address - Street 2:APT 202
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3280
Practice Address - Country:US
Practice Address - Phone:407-921-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health