Healthcare Provider Details

I. General information

NPI: 1669545539
Provider Name (Legal Business Name): RANDY SCOTT PENNEY CPD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 NORTH STREET SUITE 201
NEW BENFORD MA
02740
US

IV. Provider business mailing address

543 NORTH STREET SUITE 201
NEW BENFORD MA
02740
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-3450
  • Fax: 508-993-3455
Mailing address:
  • Phone: 508-993-3450
  • Fax: 508-993-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: