Provider Demographics
NPI:1376224717
Name:RANDOLPH-ROBLE, SADINA MARIA
Entity Type:Individual
Prefix:
First Name:SADINA
Middle Name:MARIA
Last Name:RANDOLPH-ROBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SADINA
Other - Middle Name:MARIA
Other - Last Name:CAVALIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8950 COUNTRY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2647
Mailing Address - Country:US
Mailing Address - Phone:172-730-7212
Mailing Address - Fax:
Practice Address - Street 1:10901 ROOSEVELT BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2305
Practice Address - Country:US
Practice Address - Phone:727-307-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician