Healthcare Provider Details

I. General information

NPI: 1548767809
Provider Name (Legal Business Name): SHAIBA SANDHU DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BETHESDA CT
WINSTON SALEM NC
27103-3019
US

IV. Provider business mailing address

206 N GREEN ST APT 232
WINSTON SALEM NC
27101-3151
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-8800
  • Fax: 336-277-8850
Mailing address:
  • Phone: 857-424-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0258
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number13456
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number13456
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: