Provider Demographics
NPI:1033363320
Name:MIRANDA, CELINES (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CELINES
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 STORY AVE APT 7C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2026
Mailing Address - Country:US
Mailing Address - Phone:646-286-2771
Mailing Address - Fax:
Practice Address - Street 1:511 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2737
Practice Address - Country:US
Practice Address - Phone:516-565-0388
Practice Address - Fax:516-565-2782
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018372-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist