Provider Demographics
NPI:1235374364
Name:SPRUNG, RANDI B
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:B
Last Name:SPRUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RANDI
Other - Middle Name:B
Other - Last Name:KORNHEISER-SPRUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16 ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3206
Mailing Address - Country:US
Mailing Address - Phone:516-935-1374
Mailing Address - Fax:
Practice Address - Street 1:16 ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3206
Practice Address - Country:US
Practice Address - Phone:516-935-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009523-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist