MEDICARE: SEAN AUSTIN GRADY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538859335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN AUSTIN GRADY

Provider Business Mailing Address
First Line	:	3008 GLENMORE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2203
Country	:	US
Telephone Number	:	513-389-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 GLENMORE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2203
Country	:	US
Telephone Number	:	513-389-7115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	03/19/2026

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Directions to “ SEAN AUSTIN GRADY ” Practice Location

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