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NPI Code Detail

MEDICARE: DR. SHANDY SHEA CONDIE DDS

MEDICARE:  DR. SHANDY SHEA CONDIE  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6261AZ

General Provider Information

NPI Number : 1679574404
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANDY SHEA CONDIE DDS
Provider Business Mailing Address
First Line : 4333 E SANTA FE LN
Second Line :
City : GILBERT
State : AZ
Zip : 85297-4900
Country : US
Telephone Number : 480-279-4181
Fax Number :
Provider Business Practice Location Address
First Line : 5656 S POWER RD
Second Line : ST 142
City : HIGLEY
State : AZ
Zip : 85236-5421
Country : US
Telephone Number : 480-279-3100
Fax Number : 480-279-3150
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/08/2007

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Directions to “ DR. SHANDY SHEA CONDIE DDS” Practice Location

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