Provider Demographics
NPI:1821084930
Name:EMRY, SHANNON DIONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:DIONNE
Last Name:EMRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:1200 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0998
Practice Address - Country:US
Practice Address - Phone:605-336-2140
Practice Address - Fax:605-336-1677
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics