Provider Demographics
NPI:1447905914
Name:MERY, MIRANDA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANNE
Last Name:MERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 HEATHER GLEN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5839
Mailing Address - Country:US
Mailing Address - Phone:703-774-2794
Mailing Address - Fax:
Practice Address - Street 1:197 HEATHER GLEN RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5839
Practice Address - Country:US
Practice Address - Phone:703-774-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant