Provider Demographics
NPI:1548146756
Name:SANDAHL, EMILY SHANNON (FNP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SHANNON
Last Name:SANDAHL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 E NOPAL AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6789
Mailing Address - Country:US
Mailing Address - Phone:520-975-2400
Mailing Address - Fax:
Practice Address - Street 1:8644 E NOPAL AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6789
Practice Address - Country:US
Practice Address - Phone:520-975-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ327798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily