Healthcare Provider Details

I. General information

NPI: 1821967464
Provider Name (Legal Business Name): MELANIE GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MADISON ST
WORCESTER MA
01608-2058
US

IV. Provider business mailing address

39 EISENHOWER RD
FRAMINGHAM MA
01701-2724
US

V. Phone/Fax

Practice location:
  • Phone: 774-530-6363
  • Fax: 774-530-6364
Mailing address:
  • Phone:
  • 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 State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: