Provider Demographics
NPI:1124821376
Name:MIRANDA, MISHELL D (RDN)
Entity type:Individual
Prefix:MRS
First Name:MISHELL
Middle Name:D
Last Name:MIRANDA
Suffix:
Gender:
Credentials:RDN
Other - Prefix:MRS
Other - First Name:MISHELL
Other - Middle Name:D
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:114 W 238TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4208
Mailing Address - Country:US
Mailing Address - Phone:347-717-1001
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7679
Practice Address - Country:US
Practice Address - Phone:718-518-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86290893133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered