Healthcare Provider Details

I. General information

NPI: 1548146756
Provider Name (Legal Business Name): EMILY SHANNON SANDAHL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

IV. Provider business mailing address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-9111
  • Fax: 602-222-9333
Mailing address:
  • Phone: 602-222-9111
  • Fax: 602-222-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number327798
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: