Healthcare Provider Details

I. General information

NPI: 1255331237
Provider Name (Legal Business Name): RANDI MOST PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 SUTTON PARK DR S SUITE 1504
JACKSONVILLE FL
32224-0236
US

IV. Provider business mailing address

13400 SUTTON PARK DR S SUITE 1504
JACKSONVILLE FL
32224-0236
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-5007
  • Fax: 904-223-5074
Mailing address:
  • Phone: 904-223-5007
  • Fax: 904-223-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0004903
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: