Provider Demographics
NPI:1972831758
Name:LEE, RANDI
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:LEE
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 1:54 UNDERHILL RD
Mailing Address - Street 2:APT A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7076
Mailing Address - Country:US
Mailing Address - Phone:845-988-1444
Mailing Address - Fax:
Practice Address - Street 1:54 UNDERHILL RD
Practice Address - Street 2:APT A
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7076
Practice Address - Country:US
Practice Address - Phone:845-988-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse