Provider Demographics
NPI:1851795389
Name:NUNEZ, MIRIAM J (MSED)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:J
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S CENTRAL AVE
Mailing Address - Street 2:APT. B50
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3146
Mailing Address - Country:US
Mailing Address - Phone:347-446-6959
Mailing Address - Fax:
Practice Address - Street 1:300 S CENTRAL AVE
Practice Address - Street 2:APT. B50
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3146
Practice Address - Country:US
Practice Address - Phone:347-446-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546132041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist