Healthcare Provider Details

I. General information

NPI: 1306543806
Provider Name (Legal Business Name): DESTINY R. GRANT N.D., APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE FL 3
HAMDEN CT
06517
US

IV. Provider business mailing address

134 SANFORD ST
HAMDEN CT
06514-1700
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number5.000726
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.013399
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: