Provider Demographics
NPI:1891715942
Name:SMILEY, SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SMILEY
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 1:3851 PIPER ST STE U340
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6904
Mailing Address - Country:US
Mailing Address - Phone:907-562-0321
Mailing Address - Fax:907-562-2683
Practice Address - Street 1:3851 PIPER STREET
Practice Address - Street 2:U340
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226411207R00000X
AKAK6701207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine