Provider Demographics
NPI:1417997636
Name:SHEY, RANDOLPH B (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:B
Last Name:SHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 28TH ST
Mailing Address - Street 2:SUITE #319
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-426-3656
Mailing Address - Fax:562-424-9990
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:319
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2783
Practice Address - Country:US
Practice Address - Phone:562-426-3656
Practice Address - Fax:562-424-9990
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG416192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G416190Medicaid
W6126OtherMEDICARE GROUP PTAN
CA130005308OtherRAILROAD MEDICARE
CA130005308OtherRAILROAD MEDICARE