MEDICARE: SHARI EDWARDS RANDERSON M.S

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	101YM0800X	Mental Health Counselor	8767	FL

General Provider Information

NPI Number	:	1588694574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI EDWARDS RANDERSON M.S

Provider Business Mailing Address
First Line	:	10 FAIRWAY DR
Second Line	:	SUITE 122
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1812
Country	:	US
Telephone Number	:	954-725-9263
Fax Number	:	954-725-9264

Provider Business Practice Location Address
First Line	:	10 FAIRWAY DR
Second Line	:	SUITE 122
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1812
Country	:	US
Telephone Number	:	954-725-9263
Fax Number	:	954-725-9264

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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