Healthcare Provider Details

I. General information

NPI: 1922913771
Provider Name (Legal Business Name): MIRANDA FARTHING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OLEAN RD
EAST AURORA NY
14052-9744
US

IV. Provider business mailing address

284 FORESTVIEW DR
WILLIAMSVILLE NY
14221-1438
US

V. Phone/Fax

Practice location:
  • Phone: 716-572-1654
  • Fax:
Mailing address:
  • Phone: 716-697-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: