Healthcare Provider Details

I. General information

NPI: 1184243305
Provider Name (Legal Business Name): KELLY MIRANDA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MCKEON DPM

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 402
WASHINGTON DC
20010-2989
US

IV. Provider business mailing address

106 IRVING ST NW STE 402
WASHINGTON DC
20010-2989
US

V. Phone/Fax

Practice location:
  • Phone: 202-726-1800
  • Fax: 202-726-9661
Mailing address:
  • Phone: 202-726-1800
  • Fax: 202-726-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO50083033
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: