Provider Demographics
NPI:1780045765
Name:MILLER, TARA MICHELLE (HIS)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 6TH AVENUE
Mailing Address - Street 2:TROY TOWERS, BLDG. B, 1ST FLOOR
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-273-2031
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVENUE
Practice Address - Street 2:TROY TOWERS, BLDG. B, 1ST FLOOR
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-273-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000041566237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist