Provider Demographics
NPI:1215789979
Name:WINSTON, MIRA MIRIAM
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:MIRIAM
Last Name:WINSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRYANT CRES APT 2I
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2626
Mailing Address - Country:US
Mailing Address - Phone:646-641-2005
Mailing Address - Fax:
Practice Address - Street 1:6 BRYANT CRES APT 2I
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2626
Practice Address - Country:US
Practice Address - Phone:646-641-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist