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General NPI Number Information
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NPI Number | 1609035351
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Entity Type | Individual
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Provider Name | SHAWN PATRICK EMMONS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 2131 S 17TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-7407
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Country | US
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Telephone | 910-667-2606
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Fax | 910-815-5698
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Provider Business Mailing Address
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Address Line | 346 GRAND AVE
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2580
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Country | US
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Telephone | 607-729-8156
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Fax | 607-729-3982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 250653
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 250653
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2022-00593
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License Number State | NC
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