Provider Demographics
NPI:1053807735
Name:MIRANDA SIERRA, ASHLEY M (MS)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:M
Last Name:MIRANDA SIERRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6165
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9346
Mailing Address - Country:US
Mailing Address - Phone:939-261-5018
Mailing Address - Fax:
Practice Address - Street 1:CALLE 629 KM 0.9
Practice Address - Street 2:BO LA MALDONADO
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650
Practice Address - Country:US
Practice Address - Phone:939-261-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6089103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling