Healthcare Provider Details

I. General information

NPI: 1760800684
Provider Name (Legal Business Name): SHANNON LEIGH EMERICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

12704 NE 40TH AVE
VANCOUVER WA
98686-2649
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4080
  • Fax:
Mailing address:
  • Phone: 412-916-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number61201487
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD206720
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: