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General NPI Number Information
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NPI Number | 1184243305
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Entity Type | Individual
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Provider Name | KELLY MIRANDA DPM
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Gender | Female
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 106 IRVING ST NW STE 402
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City | WASHINGTON
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State | DC
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Zip | 20010-2989
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Country | US
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Telephone | 202-726-1800
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Fax | 202-726-9661
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Provider Business Mailing Address
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Address Line | 106 IRVING ST NW STE 402
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City | WASHINGTON
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State | DC
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Zip | 20010-2989
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Country | US
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Telephone | 202-726-1800
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Fax | 202-726-9661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO50083033
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License Number State | DC
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