Healthcare Provider Details

I. General information

NPI: 1801580592
Provider Name (Legal Business Name): JOSHUA PATRICK GRADY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NW MYHRE RD FL 2
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1950 NW MYHRE RD FL 2
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-4110
  • Fax: 564-240-4088
Mailing address:
  • Phone: 564-240-4110
  • Fax: 564-240-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61454947
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: