Provider Demographics
NPI:1497452577
Name:GRANAHAN, AMANDA LEE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:GRANAHAN
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 1:44 DIAUTO DR.
Mailing Address - Street 2:
Mailing Address - City:RANOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-885-7242
Mailing Address - Fax:
Practice Address - Street 1:44 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4536
Practice Address - Country:US
Practice Address - Phone:781-885-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker