Healthcare Provider Details

I. General information

NPI: 1467375154
Provider Name (Legal Business Name): AYLISA MARIE GRENALD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S BROADWAY ST
AKRON OH
44308-1529
US

IV. Provider business mailing address

2200 STONE RIDGE CIR
BEREA OH
44017-3105
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042969
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: