Provider Demographics
NPI:1952616989
Name:RAMOS, GRISELDA (ITDS)
Entity Type:Individual
Prefix:MS
First Name:GRISELDA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 BLUE MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4024
Mailing Address - Country:US
Mailing Address - Phone:813-470-9103
Mailing Address - Fax:
Practice Address - Street 1:1544 BLUE MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4024
Practice Address - Country:US
Practice Address - Phone:813-470-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL931824222Q00000X
NY158267021222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist