MEDICARE: MRS. ILEANA MIRANDA-VELAZQUEZ CNS

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	236837	MA

General Provider Information

NPI Number	:	1902884687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILEANA MIRANDA-VELAZQUEZ CNS

Provider Business Mailing Address
First Line	:	50 PLEASANT ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-4127
Country	:	US
Telephone Number	:	413-587-7500
Fax Number	:	413-585-1355

Provider Business Practice Location Address
First Line	:	108 RUSSELL ST
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9595
Country	:	US
Telephone Number	:	413-387-0075
Fax Number	:	413-387-0074

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	02/24/2020

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