Healthcare Provider Details

I. General information

NPI: 1689566655
Provider Name (Legal Business Name): MONYAE PEARLINE RANDALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MAIN ST APT 706 PHYSICIAN ASSISTANT DEPARTMENT
SALISBURY MD
21801
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 3
SALISBURY MD
21801-5462
US

V. Phone/Fax

Practice location:
  • Phone: 410-621-3032
  • Fax:
Mailing address:
  • Phone: 443-836-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC009883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: