Provider Demographics
NPI:1487972063
Name:SHIRAISHI, EMILY S L (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:S L
Last Name:SHIRAISHI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 SW REGATTA LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8942
Mailing Address - Country:US
Mailing Address - Phone:808-321-8482
Mailing Address - Fax:503-455-4613
Practice Address - Street 1:16110 SW REGATTA LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8942
Practice Address - Country:US
Practice Address - Phone:808-321-8482
Practice Address - Fax:503-455-4613
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1169103T00000X
OR3069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist