Provider Demographics
NPI:1912742024
Name:RANDOLPH, SHENA M (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:SHENA
Middle Name:M
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:SHENA
Other - Middle Name:
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, MSW
Mailing Address - Street 1:916 LOWER DOE LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6241
Mailing Address - Country:US
Mailing Address - Phone:407-738-3913
Mailing Address - Fax:
Practice Address - Street 1:916 LOWER DOE LN
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6241
Practice Address - Country:US
Practice Address - Phone:407-738-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker