Healthcare Provider Details

I. General information

NPI: 1215247895
Provider Name (Legal Business Name): RANDI B NELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 FAR ROCKAWAY BLVD
FAR ROCKAWAY NY
11691-1941
US

IV. Provider business mailing address

2915 FAR ROCKAWAY BLVD
FAR ROCKAWAY NY
11691-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-310-6049
  • Fax: 718-310-6070
Mailing address:
  • Phone: 718-310-6049
  • Fax: 718-310-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120106
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number277840-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: