MEDICARE: VANESSA RANDO AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AY1628	FL

General Provider Information

NPI Number	:	1417260365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA RANDO AUD

Provider Business Mailing Address
First Line	:	5411 N UNIVERSITY DR
Second Line	:	STE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4637
Country	:	US
Telephone Number	:	954-752-1559
Fax Number	:	954-752-1560

Provider Business Practice Location Address
First Line	:	5411 N UNIVERSITY DR
Second Line	:	STE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4637
Country	:	US
Telephone Number	:	954-752-1559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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