Healthcare Provider Details

I. General information

NPI: 1730487018
Provider Name (Legal Business Name): RANDA MANSOUR SHOUSHER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 HOSPITAL DR STE 50
TOLEDO OH
43614-8001
US

IV. Provider business mailing address

1125 HOSPITAL DR STE 50
TOLEDO OH
43614-8001
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-4000
  • Fax:
Mailing address:
  • Phone: 419-383-4012
  • Fax: 419-383-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RANDA MANSOUR SHOUSHER
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AUD
Phone: 419-383-4012