Provider Demographics
NPI:1497080071
Name:SHELLEY, EMILY S (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 512
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-293-3636
Mailing Address - Fax:202-293-0289
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 512
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-293-3636
Practice Address - Fax:202-293-0289
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCTL1462363A00000X
DCPA030694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant