Healthcare Provider Details

I. General information

NPI: 1245882166
Provider Name (Legal Business Name): DANA GRAMAJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD CUTHBERT RD
CHERRY HILL NJ
08034-1415
US

IV. Provider business mailing address

2500 RENAISSANCE BLVD STE 170
KING OF PRUSSIA PA
19406-2639
US

V. Phone/Fax

Practice location:
  • Phone: 856-631-1223
  • Fax:
Mailing address:
  • Phone: 484-681-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90415
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: