Provider Demographics
NPI:1710949409
Name:GRANDIA, SHAWN KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:KAY
Last Name:GRANDIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:187 THOMAS JOHNSON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4445
Mailing Address - Country:US
Mailing Address - Phone:301-378-9421
Mailing Address - Fax:301-378-9529
Practice Address - Street 1:187 THOMAS JOHNSON DR STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4445
Practice Address - Country:US
Practice Address - Phone:301-378-9421
Practice Address - Fax:301-378-9529
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41421207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE84497Medicare UPIN
MD465096OtherAETNA USHEALTHCARE
MD763901500Medicaid
MD210732OtherMAMSI