Provider Demographics
NPI:1588694574
Name:RANDERSON, SHARI EDWARDS (MS)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:EDWARDS
Last Name:RANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:N
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:10 FAIRWAY DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1812
Mailing Address - Country:US
Mailing Address - Phone:954-725-9263
Mailing Address - Fax:954-725-9264
Practice Address - Street 1:10 FAIRWAY DR
Practice Address - Street 2:SUITE 122
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1812
Practice Address - Country:US
Practice Address - Phone:954-725-9263
Practice Address - Fax:954-725-9264
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health