Provider Demographics
NPI:1952440869
Name:WING, RANDEL B (DOM, LAC, NMD)
Entity type:Individual
Prefix:
First Name:RANDEL
Middle Name:B
Last Name:WING
Suffix:
Gender:M
Credentials:DOM, LAC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2687
Mailing Address - Country:US
Mailing Address - Phone:239-989-9892
Mailing Address - Fax:
Practice Address - Street 1:822 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2687
Practice Address - Country:US
Practice Address - Phone:239-989-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty