Provider Demographics
NPI:1306164876
Name:CHERIAN, SHIJU
Entity type:Individual
Prefix:DR
First Name:SHIJU
Middle Name:
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S DOVER CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4326
Mailing Address - Country:US
Mailing Address - Phone:561-853-5666
Mailing Address - Fax:
Practice Address - Street 1:311 S DOVER CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4326
Practice Address - Country:US
Practice Address - Phone:561-853-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics