Healthcare Provider Details

I. General information

NPI: 1285523621
Provider Name (Legal Business Name): SHALOM MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE 120
SPRING TX
77379-5803
US

IV. Provider business mailing address

22719 PETRIZZI LN
KATY TX
77449-8737
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone: 281-677-7447
  • Fax: 281-677-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: