Provider Demographics
NPI:1295491926
Name:NASSAR, RANDA (PA-C)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:NASSAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MAMARONECK AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2433
Mailing Address - Country:US
Mailing Address - Phone:646-240-2091
Mailing Address - Fax:
Practice Address - Street 1:440 MAMARONECK AVE STE 505
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2432
Practice Address - Country:US
Practice Address - Phone:440-462-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026825363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical