Provider Demographics
NPI:1407182199
Name:MIRANDA, SUZETTE GENEVIEVE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:GENEVIEVE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-215-6221
Mailing Address - Fax:206-215-6340
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 1650
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-215-6221
Practice Address - Fax:206-215-6340
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60290400208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery