Active NPI
Manoj Kumar Reddy Gade
- Dental Assistant
- Shamokin Dam, PA
National Provider Identifier
1639007628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- Practice address
- 30 Baldwin Blvd Ste 95
Shamokin Dam, PA 17876-9520 - Phone
- (267) 809-2364
- Fax
- (570) 256-1772
- NPI assigned
- May 11, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | PA | Primary |
Addresses
Primary practice location
30 Baldwin Blvd Ste 95
Shamokin Dam, PA 17876-9520
Mailing address
30 Baldwin Blvd Ste 95
Shamokin Dam, PA 17876-9520
Phone (267) 809-2364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778457600000",
"number": "1639007628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BALDWIN BLVD STE 95",
"city": "SHAMOKIN DAM",
"state": "PA",
"postal_code": "178769520",
"telephone_number": "267-809-2364",
"fax_number": "570-256-1772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 BALDWIN BLVD STE 95",
"city": "SHAMOKIN DAM",
"state": "PA",
"postal_code": "178769520",
"telephone_number": "267-809-2364",
"fax_number": "570-256-1772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GADE",
"first_name": "MANOJ KUMAR REDDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-11",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shamokin Dam, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.