Provider Demographics
NPI:1992533145
Name:GANDY, RANDALL KEITH
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:KEITH
Last Name:GANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 MIDDLESEX DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3009
Mailing Address - Country:US
Mailing Address - Phone:419-344-1721
Mailing Address - Fax:
Practice Address - Street 1:2674 MIDDLESEX DRIVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3009
Practice Address - Country:US
Practice Address - Phone:419-344-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant