Healthcare Provider Details

I. General information

NPI: 1659315216
Provider Name (Legal Business Name): JOSEPHINE RANDAZZO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD SUITE 20
DAYTON OH
45414-5800
US

IV. Provider business mailing address

4160 LITTLE YORK RD SUITE 20
DAYTON OH
45414-5800
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9527
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02001807
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: