Provider Demographics
NPI:1780709188
Name:MIRANDA, HEATHER LEE (RD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
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:PO BOX 17179
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-7179
Mailing Address - Country:US
Mailing Address - Phone:919-537-7479
Mailing Address - Fax:919-933-9201
Practice Address - Street 1:299 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1821
Practice Address - Country:US
Practice Address - Phone:919-537-7479
Practice Address - Fax:919-933-9201
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered