MEDICARE: MRS. MIRANDA S MOORE-STEPNITZ MS

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
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1245070374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA S MOORE-STEPNITZ MS

Provider Business Mailing Address
First Line	:	51920 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4453
Country	:	US
Telephone Number	:	586-799-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	51920 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4453
Country	:	US
Telephone Number	:	586-799-0949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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