Healthcare Provider Details

I. General information

NPI: 1821084930
Provider Name (Legal Business Name): SHANNON DIONNE EMRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0998
US

IV. Provider business mailing address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0900
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-2140
  • Fax: 605-336-1677
Mailing address:
  • Phone: 605-782-8305
  • Fax: 605-336-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6095
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: