Provider Demographics
NPI:1255331237
Name:MOST, RANDI (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:MOST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 SUTTON PARK DR S
Mailing Address - Street 2:SUITE 1504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0236
Mailing Address - Country:US
Mailing Address - Phone:904-223-5007
Mailing Address - Fax:904-223-5074
Practice Address - Street 1:13400 SUTTON PARK DR S
Practice Address - Street 2:SUITE 1504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0236
Practice Address - Country:US
Practice Address - Phone:904-223-5007
Practice Address - Fax:904-223-5074
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004903103G00000X
FLPY4903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59427Medicare ID - Type UnspecifiedBC/BS PROVIDER NUMBER