MEDICARE: TRACEY RANDALL AU.D.,F.A.A.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist		NY
2	237600000X	Audiologist-Hearing Aid Fitter	1494-1	NY

General Provider Information

NPI Number	:	1811994775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY RANDALL AU.D.,F.A.A.A

Provider Business Mailing Address
First Line	:	2623 ROUTE 52
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3215
Country	:	US
Telephone Number	:	845-226-2638
Fax Number	:	845-226-2674

Provider Business Practice Location Address
First Line	:	2623 ROUTE 52
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3215
Country	:	US
Telephone Number	:	845-226-2638
Fax Number	:	845-226-2674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	12/18/2018

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