Healthcare Provider Details

I. General information

NPI: 1912609371
Provider Name (Legal Business Name): MIRANDA PFAUTSCH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 36TH ST
VERO BEACH FL
32960-4862
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-4311
  • Fax:
Mailing address:
  • Phone: 772-567-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS21737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: