Healthcare Provider Details

I. General information

NPI: 1780212167
Provider Name (Legal Business Name): MIRANDA NORTEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 NORTHEAST EXPY NE
ATLANTA GA
30329
US

IV. Provider business mailing address

4410 DRIFTWOOD DR
PHILADELPHIA PA
19129-1783
US

V. Phone/Fax

Practice location:
  • Phone: 845-270-3455
  • Fax:
Mailing address:
  • Phone: 845-270-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: