Provider Demographics
NPI:1285063719
Name:RANDAZZO, LAURA ANN (MS SPECIAL EDUCATION)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 JOHN ROE SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2063
Mailing Address - Country:US
Mailing Address - Phone:631-766-5757
Mailing Address - Fax:
Practice Address - Street 1:2716 JOHN ROE SMITH AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2063
Practice Address - Country:US
Practice Address - Phone:631-766-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist