Provider Demographics
NPI:1821259524
Name:SHERBURNE, EMILY COUSINEAU (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:COUSINEAU
Last Name:SHERBURNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 BURNSIDE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2518
Mailing Address - Country:US
Mailing Address - Phone:504-505-0316
Mailing Address - Fax:
Practice Address - Street 1:6920 ROANOKE ROAD
Practice Address - Street 2:
Practice Address - City:SHAWSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24162
Practice Address - Country:US
Practice Address - Phone:540-268-1400
Practice Address - Fax:540-268-1300
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110-004338OtherCOMMONWEALTH OF VIRGINIA
0010-01365OtherNORTH CAROLINA MEDICAL BOARD
1081215OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS