MEDICARE: RANDILYNE NEDEDOG

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1417837345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDILYNE NEDEDOG

Provider Business Mailing Address
First Line	:	501 WILSON LN
Second Line	:
City	:	ELKINS
State	:	WV
Zip	:	26241-5216
Country	:	US
Telephone Number	:	304-636-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 BOWERS WOODS EDGE LN
Second Line	:
City	:	SENECA ROCKS
State	:	WV
Zip	:	26884-8505
Country	:	US
Telephone Number	:	304-844-6852
Fax Number	:

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ RANDILYNE NEDEDOG ” Practice Location

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