Individual provider Active NPI

Miranda Feliciano, LPN

  • Licensed Practical Nurse
  • Pavilion, NY
National Provider Identifier
1154147684
Registry record updated Nov 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
338340 Issued in NY
Practice address
9540 Warsaw Rd
Pavilion, NY 14525-9741
Phone
(716) 331-1993
NPI assigned
Nov 30, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 338340 NY Primary

Addresses

Primary practice location

9540 Warsaw Rd
Pavilion, NY 14525-9741

Mailing address

9540 Warsaw Rd
Pavilion, NY 14525-9741
Phone (716) 331-1993

Other names 1

  • Miranda Wisniewski Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
338340NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732924800000",
    "number": "1154147684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9540 WARSAW RD",
            "city": "PAVILION",
            "state": "NY",
            "postal_code": "145259741",
            "telephone_number": "716-331-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9540 WARSAW RD",
            "city": "PAVILION",
            "state": "NY",
            "postal_code": "145259741",
            "telephone_number": "716-331-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELICIANO",
        "first_name": "MIRANDA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-30",
        "last_updated": "2024-11-30",
        "certification_date": "2024-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "338340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "WISNIEWSKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pavilion, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.