MEDICARE: RAYSEAN GRANDISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1144170143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYSEAN GRANDISON

Provider Business Mailing Address
First Line	:	4006 MARIPOSA DR
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-1666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 TEMPLE LAKE DR STE 5
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-4902
Country	:	US
Telephone Number	:	804-988-1150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ RAYSEAN GRANDISON ” Practice Location

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