Provider Demographics
NPI:1396166575
Name:BISBANO, RANDI NICOLE (MS, RN, PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:RANDI
Middle Name:NICOLE
Last Name:BISBANO
Suffix:
Gender:F
Credentials:MS, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 EAST AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2615
Mailing Address - Country:US
Mailing Address - Phone:585-434-2633
Mailing Address - Fax:585-434-2635
Practice Address - Street 1:339 EAST AVE STE 303
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2615
Practice Address - Country:US
Practice Address - Phone:585-434-2633
Practice Address - Fax:585-434-2635
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602014163WP0807X
AZRN201885163WP0808X
AZAP8980364SP0808X
NY401671363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health