Provider Demographics
NPI:1184410920
Name:GRUNDY, ERIC DESHAUNE SR
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DESHAUNE
Last Name:GRUNDY
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MULL AVE APT PH23
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7526
Mailing Address - Country:US
Mailing Address - Phone:330-780-0397
Mailing Address - Fax:
Practice Address - Street 1:935 MULL AVE APT PH23
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7526
Practice Address - Country:US
Practice Address - Phone:330-780-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRG955776172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver