MEDICARE: SHANNON SMILEY M.D.

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	226411	NY
2	207RH0003X	Hematology & Oncology Physician	AK6701	AK

General Provider Information

NPI Number	:	1891715942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SMILEY M.D.

Provider Business Mailing Address
First Line	:	3851 PIPER ST STE U340
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-6904
Country	:	US
Telephone Number	:	907-562-0321
Fax Number	:	907-562-2683

Provider Business Practice Location Address
First Line	:	3851 PIPER STREET
Second Line	:	U340
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4627
Country	:	US
Telephone Number	:	907-562-0321
Fax Number	:	907-562-2683

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/23/2021

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Directions to “ SHANNON SMILEY M.D.” Practice Location

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