Individual provider Active NPI

Thesalee Nicola Randon, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Coral Gables, FL
National Provider Identifier
1194811158
Registry record updated Apr 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
ME117952 Issued in FL
Practice address
5955 Pouce de Leon Blvd.
Coral Gables, FL 33146
Phone
(305) 661-1515
Fax
(305) 662-3723
NPI assigned
Oct 5, 2006
Last updated
Apr 14, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 064250 GA
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD036205 DC
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X ME117952 FL Primary

Addresses

Primary practice location

5955 Pouce de Leon Blvd.
Coral Gables, FL 33146

Mailing address

5955 Pouce de Leon Blvd.
Coral Gables, FL 33146
Phone (305) 661-1515

Other identifiers 1

IdentifierTypeStateIssuer
003119777AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
064250GAMDPediatrics Physician
MD036205DCMDPediatric Emergency Medicine (Pediatrics) Physician
ME117952FLMDPediatric Emergency Medicine (Pediatrics) Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397433600000",
    "number": "1194811158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 POUCE DE LEON BLVD.",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "33146",
            "telephone_number": "305-661-1515",
            "fax_number": "305-662-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 POUCE DE LEON BLVD.",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "33146",
            "telephone_number": "305-661-1515",
            "fax_number": "305-662-3723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDON",
        "first_name": "THESALEE",
        "middle_name": "NICOLA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2014-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "064250",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "DC",
            "license": "MD036205",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME117952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003119777A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Gables, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.