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1699777524

NPI Code Detail

MEDICARE: DR. SHANDAL S EMANUEL MD

MEDICARE: DR. SHANDAL S EMANUEL MD

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	207R00000X	Internal Medicine Physician	200500405	NC
2	208000000X	Pediatrics Physician	200500405	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	313413	OTHER	NC	WELLPATH ID
2	6114784	OTHER	NC	CIGNA ID
3	5607350	OTHER	NC	FIRST HEALTH ID
4	14015	OTHER	NC	BC/BS ID
5	7740703	OTHER	NC	AETNA ID
6	E3288	OTHER	NC	MEDCOST ID

General Provider Information

NPI Number	:	1699777524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANDAL S EMANUEL MD

Provider Business Mailing Address
First Line	:	107 W NASHVILLE DR STE A
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1289
Country	:	US
Telephone Number	:	252-676-8285
Fax Number	:	252-507-0771

Provider Business Practice Location Address
First Line	:	107 W NASHVILLE DR STE A
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1289
Country	:	US
Telephone Number	:	252-676-8285
Fax Number	:	252-507-0771

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/18/2023

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Directions to “ DR. SHANDAL S EMANUEL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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