Healthcare Provider Details

I. General information

NPI: 1548187594
Provider Name (Legal Business Name): AMANDA ANN RANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DICKINSON ST APT D
FREMONT OH
43420-1160
US

IV. Provider business mailing address

1630 DICKINSON ST APT D
FREMONT OH
43420-1160
US

V. Phone/Fax

Practice location:
  • Phone: 419-603-7730
  • Fax:
Mailing address:
  • Phone: 419-603-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number0221228
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: