Healthcare Provider Details

I. General information

NPI: 1851406490
Provider Name (Legal Business Name): ANDREW SHEMELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 FRONT ST
GREENPORT NY
11944-1516
US

IV. Provider business mailing address

310 FRONT ST
GREENPORT NY
11944-1516
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-0123
  • Fax:
Mailing address:
  • Phone: 631-477-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number035938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: