Healthcare Provider Details

I. General information

NPI: 1437123783
Provider Name (Legal Business Name): MELANIE ETHELL MIRANDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 MARKET AVE N SUITE 101
CANTON OH
44721-2430
US

IV. Provider business mailing address

6525 MARKET AVE N SUITE 101
CANTON OH
44721-2430
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-9785
  • Fax: 330-494-9798
Mailing address:
  • Phone: 330-494-9785
  • Fax: 330-494-9798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35072373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: