Provider Demographics
NPI:1871770917
Name:MIRANDA, ANETRA SHARICE (DPM)
Entity type:Individual
Prefix:
First Name:ANETRA
Middle Name:SHARICE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANETRA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6445 FM 1463 RD STE 160-213
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4027
Mailing Address - Country:US
Mailing Address - Phone:866-925-5662
Mailing Address - Fax:866-925-5662
Practice Address - Street 1:5373 W ALABAMA ST STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5923
Practice Address - Country:US
Practice Address - Phone:866-925-5662
Practice Address - Fax:866-925-5662
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2125213ES0103X
MS80195213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery