Provider Demographics
NPI:1770504664
Name:SHEILA L MIRANDA MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHEILA L MIRANDA MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-949-0885
Mailing Address - Street 1:9811 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 2543
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-256-3637
Mailing Address - Fax:702-256-3307
Practice Address - Street 1:9811 W CHARLESTON BLVD
Practice Address - Street 2:2543
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7528
Practice Address - Country:US
Practice Address - Phone:702-949-0885
Practice Address - Fax:702-951-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770504664OtherGROUP NPI
NV1770504664OtherNPI GROUP
NV100504137Medicaid
NV1770504664OtherNPI GROUP
NVI18736Medicare UPIN