Provider Demographics
NPI:1417599283
Name:RANDELL, SHIRA
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:RANDELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:BORKON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:481 MAIN STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-355-2440
Mailing Address - Fax:
Practice Address - Street 1:481 MAIN STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-355-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health