Provider Demographics
NPI:1053831479
Name:RANDAZZO, MELISSA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLLEGE PLAZA PEDIATRICS
Mailing Address - Street 2:765 ROUTE 10 EAST, STE 203
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-659-9991
Mailing Address - Fax:973-659-9632
Practice Address - Street 1:COLLEGE PLAZA PEDIATRICS
Practice Address - Street 2:765 ROUTE 10 EAST, STE 203
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-659-9991
Practice Address - Fax:973-659-9632
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA1059350208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program