Provider Demographics
NPI:1831875582
Name:RANDALL, SYDNEY ANNE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ANNE
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 1:4519 S 167TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1356
Mailing Address - Country:US
Mailing Address - Phone:612-578-2530
Mailing Address - Fax:
Practice Address - Street 1:4519 S 167TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1356
Practice Address - Country:US
Practice Address - Phone:612-578-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program