Healthcare Provider Details

I. General information

NPI: 1669338547
Provider Name (Legal Business Name): EMERALD SHOCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 DANA AVE
CINCINNATI OH
45207-1340
US

IV. Provider business mailing address

141 WELLINGTON PL UNIT A208
CINCINNATI OH
45219-2693
US

V. Phone/Fax

Practice location:
  • Phone: 513-601-0313
  • Fax:
Mailing address:
  • Phone: 513-801-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number539629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: