| Doctor Name: | DR. RANDI NICHOLS MCDONALD |
| NPI Number: | 1619111721 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PY60026315 |
| Business Practice Address: | 1270 Eglin Pkwy Suite C-12 Shalimar, FL - 325792306 |
| Business Phone Number: | 8506136677 |
| Business Fax Number: | 8506136993 |
| Mailing Address: | 1270 Eglin Pkwy, Suite C-12 SHALIMAR |
| State: | FL |
| Postal Code: | 325792306 |
| Phone Number: | 8506136677 |
| Fax Number: | 8506136993 |
| NPI Enumeration Date: | 04/21/2009 |
| NPI Last Update Date: | 04/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY60026315 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |