Healthcare Provider Details

I. General information

NPI: 1821085671
Provider Name (Legal Business Name): SIDNEY RANDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 CORAL RIDGE DR STE 300
CORAL SPRINGS FL
33076-3377
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-414-7700
  • Fax: 954-840-0850
Mailing address:
  • Phone: 954-414-7700
  • Fax: 954-840-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME48273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: