Provider Demographics
NPI:1003780891
Name:HEDGES, MIRANDA MARY
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARY
Last Name:HEDGES
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:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0902
Mailing Address - Country:US
Mailing Address - Phone:631-655-6789
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1537
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-0902
Practice Address - Country:US
Practice Address - Phone:631-298-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program