Provider Demographics
NPI:1417184219
Name:GRANT, RASHEEDAH V (PA)
Entity type:Individual
Prefix:MS
First Name:RASHEEDAH
Middle Name:V
Last Name:GRANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BURKE AVE
Mailing Address - Street 2:APT 6H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5031
Mailing Address - Country:US
Mailing Address - Phone:917-656-6360
Mailing Address - Fax:
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:ROOM 8-004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-342-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0132621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant