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General NPI Number Information
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NPI Number | 1265122378
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Entity Type | Individual
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Provider Name | MELISSA GISELLE MIRANDA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 12220 USF MANGO DR
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City | TAMPA
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State | FL
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Zip | 33620-0001
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Country | US
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Telephone | 813-974-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W CHESTNUT ST UNIT 232
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City | TAMPA
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State | FL
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Zip | 33607-4480
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Country | US
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Telephone | 352-208-7688
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY12901
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License Number State | FL
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