Provider Demographics
NPI:1164976130
Name:ANDO, SHIHO (ATC)
Entity Type:Individual
Prefix:MS
First Name:SHIHO
Middle Name:
Last Name:ANDO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MATHILDA DR
Mailing Address - Street 2:APT.5
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2629
Mailing Address - Country:US
Mailing Address - Phone:805-259-9236
Mailing Address - Fax:
Practice Address - Street 1:285 MATHILDA DR
Practice Address - Street 2:APT.5
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2629
Practice Address - Country:US
Practice Address - Phone:805-259-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000179052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer