Provider Demographics
NPI:1841430626
Name:RANDAZZO, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RANDAZZO
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:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1081
Mailing Address - Country:US
Mailing Address - Phone:813-601-3502
Mailing Address - Fax:
Practice Address - Street 1:4914 HIDDEN HILLS LN.
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545
Practice Address - Country:US
Practice Address - Phone:813-601-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-1878103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst