Healthcare Provider Details

I. General information

NPI: 1538085659
Provider Name (Legal Business Name): EMILY JORDAN SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

350 GORDON ST
IRWIN PA
15642-1306
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-1000
  • Fax:
Mailing address:
  • Phone: 724-610-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067887
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: