Provider Demographics
NPI:1578279865
Name:BUZA, MIRANDA
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:BUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:NOVOTNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:623 ROME GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9320
Mailing Address - Country:US
Mailing Address - Phone:440-212-4760
Mailing Address - Fax:
Practice Address - Street 1:623 ROME GREENWICH RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9320
Practice Address - Country:US
Practice Address - Phone:440-212-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator