Provider Demographics
NPI:1194039800
Name:GRIGSBY, MELANDY MIA (M S)
Entity Type:Individual
Prefix:MRS
First Name:MELANDY
Middle Name:MIA
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 EMERALD DUNES DR APT 208
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2771
Mailing Address - Country:US
Mailing Address - Phone:413-821-4088
Mailing Address - Fax:
Practice Address - Street 1:6511 EMERALD DUNES DR APT 208
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2771
Practice Address - Country:US
Practice Address - Phone:413-821-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid