Provider Demographics
NPI:1144459561
Name:GRANA, JAMIRA R (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIRA
Middle Name:R
Last Name:GRANA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JAMIRA
Other - Middle Name:R
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2901 BAYSHORE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5511
Mailing Address - Country:US
Mailing Address - Phone:813-831-6566
Mailing Address - Fax:813-831-6566
Practice Address - Street 1:2901 BAYSHORE VISTA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5511
Practice Address - Country:US
Practice Address - Phone:813-831-6566
Practice Address - Fax:813-831-6566
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist