Healthcare Provider Details

I. General information

NPI: 1023848678
Provider Name (Legal Business Name): KIRA MIRANDA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRA FEAR MIRANDA

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 KYLE WOOD LN
BRANDON FL
33511-4850
US

IV. Provider business mailing address

5120 S FLORIDA AVE STE 301
LAKELAND FL
33813-2527
US

V. Phone/Fax

Practice location:
  • Phone: 813-548-7259
  • Fax:
Mailing address:
  • Phone: 863-619-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: