Healthcare Provider Details

I. General information

NPI: 1083356547
Provider Name (Legal Business Name): EMILY R SHEVELAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-6425
  • Fax:
Mailing address:
  • Phone: 317-278-6425
  • Fax: 407-649-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number01100553A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: