Provider Demographics
NPI:1821085671
Name:RANDEL, SIDNEY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:RANDEL
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-414-7700
Mailing Address - Fax:954-840-0850
Practice Address - Street 1:5810 CORAL RIDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3377
Practice Address - Country:US
Practice Address - Phone:954-414-7700
Practice Address - Fax:954-840-0850
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045879100Medicaid