Provider Demographics
NPI:1073811105
Name:RANDOLPH, SHAUNDA ELZABETH
Entity Type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:ELZABETH
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHAUNDA
Other - Middle Name:ELIZABETH
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6050 34TH ST W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3657
Mailing Address - Country:US
Mailing Address - Phone:941-580-4654
Mailing Address - Fax:941-746-1774
Practice Address - Street 1:6050 34TH ST W
Practice Address - Street 2:SUITE 310
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3657
Practice Address - Country:US
Practice Address - Phone:941-580-4654
Practice Address - Fax:941-746-1774
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care