Healthcare Provider Details

I. General information

NPI: 1669362034
Provider Name (Legal Business Name): MIREYA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 N MERIDIAN ST
CARMEL IN
46032-6934
US

IV. Provider business mailing address

9995 WHITE JASMINE DR
SAINT JOHN IN
46373-0468
US

V. Phone/Fax

Practice location:
  • Phone: 770-538-1770
  • Fax:
Mailing address:
  • Phone: 219-801-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: