Provider Demographics
NPI:1770741761
Name:RANDO, VANESSA HELENA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:HELENA
Last Name:RANDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:HELENA
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 SCOBEE CIR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4887
Mailing Address - Country:US
Mailing Address - Phone:508-747-0711
Mailing Address - Fax:508-746-9265
Practice Address - Street 1:1 SCOBEE CIR
Practice Address - Street 2:UNIT 3
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4887
Practice Address - Country:US
Practice Address - Phone:508-747-0711
Practice Address - Fax:508-746-9265
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant