Provider Demographics
NPI:1336919646
Name:RANDALL, SHARLENE
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:RANDALL
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 1:554 CONNECTICUT AVE APT 439
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1732
Mailing Address - Country:US
Mailing Address - Phone:347-552-9159
Mailing Address - Fax:
Practice Address - Street 1:554 CONNECTICUT AVE APT 439
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1732
Practice Address - Country:US
Practice Address - Phone:347-552-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor