Provider Demographics
NPI:1679791420
Name:SHAND, CALLIEF SHEREEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALLIEF
Middle Name:SHEREEN
Last Name:SHAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 HOYT ST
Mailing Address - Street 2:APT 9
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1606
Mailing Address - Country:US
Mailing Address - Phone:850-445-0152
Mailing Address - Fax:
Practice Address - Street 1:1338 SOUTH BLVD
Practice Address - Street 2:DENTAL
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076745000Medicaid