Provider Demographics
NPI:1922038678
Name:SHOUSHER, RANDA MANSOUR (AUD)
Entity Type:Individual
Prefix:DR
First Name:RANDA
Middle Name:MANSOUR
Last Name:SHOUSHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 HOSPITAL DR STE 50
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8001
Mailing Address - Country:US
Mailing Address - Phone:419-383-4012
Mailing Address - Fax:419-383-6126
Practice Address - Street 1:1125 HOSPITAL DR STE 50
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8001
Practice Address - Country:US
Practice Address - Phone:419-383-4012
Practice Address - Fax:419-383-6126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 00529231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721928Medicaid
OH0721928Medicaid