Provider Demographics
NPI:1821090150
Name:EMERY, SHAWN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:CLARK
Last Name:EMERY
Suffix:
Gender:M
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:PO BOX 576768
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6768
Mailing Address - Country:US
Mailing Address - Phone:209-723-4551
Mailing Address - Fax:209-723-0141
Practice Address - Street 1:3172 COLLINS DR STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3131
Practice Address - Country:US
Practice Address - Phone:209-723-4551
Practice Address - Fax:209-723-0141
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11379207ZP0102X
CAA77415207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV201672000Medicaid
NVXPY068120OtherMEDICAL
CA00A774150Medicaid
NVI29101Medicare UPIN
NVXPY068120OtherMEDICAL
NVV9L0008062Medicare ID - Type Unspecified