Provider Demographics
NPI:1932143617
Name:GRANDO, ROY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:GRANDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2998 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-9075
Mailing Address - Country:US
Mailing Address - Phone:480-275-4063
Mailing Address - Fax:
Practice Address - Street 1:3250 N PINAL PKWY
Practice Address - Street 2:MEDICAL UNIT
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9459
Practice Address - Country:US
Practice Address - Phone:520-868-8443
Practice Address - Fax:520-868-1547
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3945103T00000X
MOPY 00833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S18330Medicare UPIN