Healthcare Provider Details

I. General information

NPI: 1376532580
Provider Name (Legal Business Name): SHAHID RASUL RANDHAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E OAKLAND PARK BLVD
FORT LAUDERDALE FL
33306-1601
US

IV. Provider business mailing address

5333 N DIXIE HWY STE 109
OAKLAND PARK FL
33334-3453
US

V. Phone/Fax

Practice location:
  • Phone: 954-717-1919
  • Fax: 954-717-2528
Mailing address:
  • Phone: 954-717-1919
  • Fax: 954-717-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME92264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: