Provider Demographics
NPI:1083100168
Name:MIELE, MIRANDA ANTOINETTE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANTOINETTE
Last Name:MIELE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0960
Mailing Address - Country:US
Mailing Address - Phone:617-774-1717
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST STE 2B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0960
Practice Address - Country:US
Practice Address - Phone:617-774-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4741-SP-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist