Healthcare Provider Details

I. General information

NPI: 1255252490
Provider Name (Legal Business Name): ANTHONY ROY RANDO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

1116 MOORE ST APT A
FREMONT OH
43420-1709
US

IV. Provider business mailing address

1116 MOORE ST APT A
FREMONT OH
43420-1709
US

V. Phone/Fax

Practice location:
  • Phone: 419-707-4253
  • Fax:
Mailing address:
  • Phone: 419-707-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number0168713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: