Healthcare Provider Details

I. General information

NPI: 1710949409
Provider Name (Legal Business Name): SHAWN KAY GRANDIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/06/2020
Certification Date: 06/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 THOMAS JOHNSON DR STE 1
FREDERICK MD
21702-4445
US

IV. Provider business mailing address

187 THOMAS JOHNSON DR STE 1
FREDERICK MD
21702-4445
US

V. Phone/Fax

Practice location:
  • Phone: 301-378-9421
  • Fax: 301-378-9529
Mailing address:
  • Phone: 301-378-9421
  • Fax: 301-378-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberD41421
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: