Provider Demographics
NPI:1326743816
Name:GRANT, MARION SANDRA-DEE
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:SANDRA-DEE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-2419
Mailing Address - Country:US
Mailing Address - Phone:203-572-9335
Mailing Address - Fax:
Practice Address - Street 1:294 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-2419
Practice Address - Country:US
Practice Address - Phone:203-572-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management