Provider Demographics
NPI:1447813837
Name:TODD, EMILY RENEE (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:TODD
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Gender:F
Credentials:PA
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Mailing Address - Street 1:8 N JEFFERSON ST APT 506
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-1935
Mailing Address - Country:US
Mailing Address - Phone:336-972-4743
Mailing Address - Fax:
Practice Address - Street 1:2020 N PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4851
Practice Address - Country:US
Practice Address - Phone:336-768-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2020-01-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant