Healthcare Provider Details

I. General information

NPI: 1922484898
Provider Name (Legal Business Name): MIRANDA SAINT-LOUIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 125B
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST STE 125B
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 516-469-1406
  • Fax:
Mailing address:
  • Phone: 516-469-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339763
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013250
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: