Provider Demographics
NPI:1720423494
Name:MIRANDA, ALEJANDRA ALEJANDRA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:ALEJANDRA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MARYORY
Other - Middle Name:ALEJANDRA
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1314 5TH AVE
Mailing Address - Street 2:UNIT 1325
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:516-768-8181
Mailing Address - Fax:
Practice Address - Street 1:1314 5TH AVE
Practice Address - Street 2:UNIT 1325
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:516-768-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist