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NPI Code Detail

MEDICARE: DR. GIRA ILEANA GRACIANO MIRELES MD

MEDICARE: DR. GIRA ILEANA GRACIANO MIRELES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician319751NY
2390200000XStudent in an Organized Health Care Education/Training Program319751NY
32084N0400XNeurology Physician25MA13124100NJ

General Provider Information

NPI Number : 1154986255
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GIRA ILEANA GRACIANO MIRELES MD
Provider Business Mailing Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number : 347-798-9213
Fax Number :
Provider Business Practice Location Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number : 347-798-9213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2019
Last Update Date : 05/27/2026

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