Provider Demographics
NPI:1679060651
Name:RANDLE, SHERMAL
Entity Type:Individual
Prefix:
First Name:SHERMAL
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 S PADRE ISLAND DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4059
Mailing Address - Country:US
Mailing Address - Phone:361-360-8700
Mailing Address - Fax:361-687-2605
Practice Address - Street 1:6500 S PADRE ISLAND DR STE 1A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4059
Practice Address - Country:US
Practice Address - Phone:361-360-8700
Practice Address - Fax:361-687-2605
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies