Basic Information
| Provider Information | |||||||||
| NPI: | 1679108559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, CRNP, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 COLLINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HADDON TWP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081071813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564042113 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 925 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159555050 | ||||||||
| FaxNumber: | 2155035650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2020 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0001X | 26NJ00984300 | NJ | N | 207RA0001X | SP021479 | PA | Y |
No ID Information.