Provider Demographics
NPI:1598297939
Name:SEIVANE, RANDOLPH
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:SEIVANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 SW 131ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4028
Mailing Address - Country:US
Mailing Address - Phone:786-506-3394
Mailing Address - Fax:
Practice Address - Street 1:4432 SW 131ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4028
Practice Address - Country:US
Practice Address - Phone:786-506-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020336700Medicaid