Provider Demographics
NPI:1386272268
Name:SHANKS, EMMILY LAURETTE (DO)
Entity type:Individual
Prefix:
First Name:EMMILY
Middle Name:LAURETTE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 DIXMYTH AVE # 10
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2475
Mailing Address - Country:US
Mailing Address - Phone:513-862-2850
Mailing Address - Fax:513-862-7052
Practice Address - Street 1:375 DIXMYTH AVE # 10
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2850
Practice Address - Fax:513-862-7052
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0154692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry