Provider Demographics
NPI:1902172125
Name:VAJDAK, RANDA SUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:SUE
Last Name:VAJDAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 COPPERFIELD DR.
Mailing Address - Street 2:STE 105
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-776-1660
Mailing Address - Fax:979-776-1314
Practice Address - Street 1:3740 COPPERFIELD DR.
Practice Address - Street 2:STE 105
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-1660
Practice Address - Fax:979-776-1314
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02991364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical