MEDICARE: DIANA MIRANDA

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	104100000X	Social Worker	44SL06345400	NJ

General Provider Information

NPI Number	:	1922603224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MIRANDA

Provider Business Mailing Address
First Line	:	5102 BLUE JAY WAY
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-5421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5102 BLUE JAY WAY
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-5421
Country	:	US
Telephone Number	:	609-356-8129
Fax Number	:

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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Directions to “ DIANA MIRANDA ” Practice Location

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