Healthcare Provider Details

I. General information

NPI: 1962323006
Provider Name (Legal Business Name): AMANDA L GAYLER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA L RANDOLPH CDCA

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 N SYLVAN AVE APT L
COLUMBUS OH
43204-1336
US

IV. Provider business mailing address

58 N SYLVAN AVE APT L
COLUMBUS OH
43204-1336
US

V. Phone/Fax

Practice location:
  • Phone: 614-456-8882
  • Fax:
Mailing address:
  • Phone: 614-456-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number195090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: