Healthcare Provider Details

I. General information

NPI: 1841169844
Provider Name (Legal Business Name): SHANDY L GRANTHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

IV. Provider business mailing address

1916 RISBOROUGH CT
BAKERSFIELD CA
93311-8432
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-8223
  • Fax:
Mailing address:
  • Phone: 661-549-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: