MEDICARE: DR. CALLIEF SHEREEN SHAND D.D.S.

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
1	122300000X	Dentist	17889	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679791420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALLIEF SHEREEN SHAND D.D.S.

Provider Business Mailing Address
First Line	:	774 HOYT ST
Second Line	:	APT 9
City	:	CHIPLEY
State	:	FL
Zip	:	32428-1606
Country	:	US
Telephone Number	:	850-445-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 SOUTH BLVD
Second Line	:	DENTAL
City	:	CHIPLEY
State	:	FL
Zip	:	32428-1846
Country	:	US
Telephone Number	:	850-638-6240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/01/2009

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