Provider Demographics
NPI:1699517052
Name:GIVENS, RAYANDRAL N
Entity type:Individual
Prefix:
First Name:RAYANDRAL
Middle Name:N
Last Name:GIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9671 COUNTY ROAD 127
Mailing Address - Street 2:
Mailing Address - City:SANDERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32087-2275
Mailing Address - Country:US
Mailing Address - Phone:904-860-2061
Mailing Address - Fax:
Practice Address - Street 1:9604 ARLIE GIVENS LN
Practice Address - Street 2:
Practice Address - City:SANDERSON
Practice Address - State:FL
Practice Address - Zip Code:32087-2214
Practice Address - Country:US
Practice Address - Phone:904-275-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty