Provider Demographics
NPI:1275920290
Name:GRANDYS, DEBORAH (RD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GRANDYS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 BROADWAY
Mailing Address - Street 2:SUITE D1
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8602
Mailing Address - Country:US
Mailing Address - Phone:219-750-9497
Mailing Address - Fax:219-359-3181
Practice Address - Street 1:8300 BROADWAY
Practice Address - Street 2:SUITE D1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8602
Practice Address - Country:US
Practice Address - Phone:219-750-9497
Practice Address - Fax:219-359-3181
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001319A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered