MEDICARE: MIRANDA ROTUNNO

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	363A00000X	Physician Assistant	PA19875	TX

General Provider Information

NPI Number	:	1427846526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA ROTUNNO

Provider Business Mailing Address
First Line	:	8619 SOUTHWESTERN BLVD APT 1026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-8252
Country	:	US
Telephone Number	:	512-925-1572
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W 15TH ST STE 180
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5836
Country	:	US
Telephone Number	:	972-566-5255
Fax Number	:

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

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	01/21/2026

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Directions to “ MIRANDA ROTUNNO ” Practice Location

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