Healthcare Provider Details

I. General information

NPI: 1740795392
Provider Name (Legal Business Name): OLIVIA RANDALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2270
US

IV. Provider business mailing address

37255 JACKSON RD
MORELAND HILLS OH
44022-1923
US

V. Phone/Fax

Practice location:
  • Phone: 216-218-1452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: