Provider Demographics
NPI:1275796732
Name:GOLDSTEIN, JESSICA HELENA RANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HELENA RANDA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:HELENA
Other - Last Name:RANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE BLDG FLOOR12
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-365-6777
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE BLDG FLOOR12
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-05
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69877208000000X, 2084N0402X, 2084N0402X
390200000X
OH35.1232612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program