Healthcare Provider Details

I. General information

NPI: 1316622061
Provider Name (Legal Business Name): JANEL LEIGH GRANT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

IV. Provider business mailing address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

V. Phone/Fax

Practice location:
  • Phone: 484-602-2514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOT022474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: