Provider Demographics
NPI:1285455972
Name:GRADY, FELICIA L
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:L
Last Name:GRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218
Mailing Address - Country:US
Mailing Address - Phone:317-658-5927
Mailing Address - Fax:
Practice Address - Street 1:2424 DR. MLK
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208
Practice Address - Country:US
Practice Address - Phone:317-658-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals