Provider Demographics
NPI:1508092107
Name:SHISHIDO, SONIA (DO)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:SHISHIDO
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 1:10619 S JORDAN GTWY # 300
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3969
Mailing Address - Country:US
Mailing Address - Phone:888-543-8228
Mailing Address - Fax:770-701-6673
Practice Address - Street 1:MID COLUMBIA MEDICAL CENTER, OPERATING ROOMS
Practice Address - Street 2:1700 EAST 19TH STREET
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-9705
Practice Address - Country:US
Practice Address - Phone:541-296-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1695207R00000X
ORDO161659207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine