Healthcare Provider Details

I. General information

NPI: 1144676495
Provider Name (Legal Business Name): CYNTHIA A MIRANDA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MANSION ST
NEW HAVEN CT
06512-3948
US

IV. Provider business mailing address

27 MANSION ST
NEW HAVEN CT
06512-3948
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-3000
  • Fax: 203-688-3050
Mailing address:
  • Phone: 203-688-3000
  • Fax: 203-688-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4176
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: