Healthcare Provider Details

I. General information

NPI: 1235775800
Provider Name (Legal Business Name): EMILY CHRISTINE SHATTUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ALLAN

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 INDEPENDENCE PT FL 4
GREENVILLE SC
29615-4566
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-3700
  • Fax: 864-522-3705
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number7500057A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number131
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: