Provider Demographics
NPI:1972951010
Name:MIRANDA, CYNTHIA (RD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2742
Mailing Address - Country:US
Mailing Address - Phone:401-721-9200
Mailing Address - Fax:401-729-0010
Practice Address - Street 1:621 DEXTER ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2742
Practice Address - Country:US
Practice Address - Phone:401-721-9200
Practice Address - Fax:401-729-0010
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00047133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered