Provider Demographics
NPI:1649863028
Name:PAREDES, MYRIAM N
Entity type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:N
Last Name:PAREDES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2202
Mailing Address - Country:US
Mailing Address - Phone:732-688-8751
Mailing Address - Fax:
Practice Address - Street 1:408 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2110
Practice Address - Country:US
Practice Address - Phone:732-688-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01092100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner