Provider Demographics
NPI:1720349277
Name:MIRANDO, STEVEN MATTHEW
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MATTHEW
Last Name:MIRANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MONIQUE DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1019
Mailing Address - Country:US
Mailing Address - Phone:617-571-5232
Mailing Address - Fax:
Practice Address - Street 1:29 MONIQUE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1019
Practice Address - Country:US
Practice Address - Phone:617-571-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program