Healthcare Provider Details

I. General information

NPI: 1407815913
Provider Name (Legal Business Name): SONNY MALAGAYO MIRANDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 SYKESVILLE ROAD SPRINGFIELD HOSPITAL CENTER
SYKESVILLE MD
21784
US

IV. Provider business mailing address

6130 JERRYS DRIVE
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-2100
  • Fax:
Mailing address:
  • Phone: 410-997-7265
  • Fax: 410-997-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD30454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: