Healthcare Provider Details

I. General information

NPI: 1013971332
Provider Name (Legal Business Name): SHERRIE N MIRANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR SUITE 3500
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE 3500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax: 304-691-1375
Mailing address:
  • Phone: 304-691-1300
  • Fax: 304-691-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17048
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: