Provider Demographics
NPI:1538327077
Name:SHISHEHBOR, ANDREA LONDONO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LONDONO
Last Name:SHISHEHBOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LONDONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3758 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2244
Mailing Address - Country:US
Mailing Address - Phone:440-479-2535
Mailing Address - Fax:216-320-9810
Practice Address - Street 1:3758 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2244
Practice Address - Country:US
Practice Address - Phone:440-479-2535
Practice Address - Fax:216-320-9810
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist