Provider Demographics
NPI:1407734858
Name:OCTAVE, ROSE MIRANDA (RD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MIRANDA
Last Name:OCTAVE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MIRANDA
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 CONCORD LN BLDG 11
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6656
Mailing Address - Country:US
Mailing Address - Phone:845-648-9224
Mailing Address - Fax:
Practice Address - Street 1:221 CONCORD LN BLDG 11
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6656
Practice Address - Country:US
Practice Address - Phone:845-648-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered