Healthcare Provider Details

I. General information

NPI: 1336059088
Provider Name (Legal Business Name): NIYAH GRANSBURY MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 GEORGE WASHINGTON MEM HWY STE C
YORKTOWN VA
23692-2619
US

IV. Provider business mailing address

2801 OLD WILLIAMSBURG RD APT 5C
YORKTOWN VA
23690-3808
US

V. Phone/Fax

Practice location:
  • Phone: 804-366-4276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: