Provider Demographics
NPI:1487148318
Name:SHANDLEY, COLLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:SHANDLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 HOFFMAN BLVD STE #300
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192
Mailing Address - Country:US
Mailing Address - Phone:224-612-3191
Mailing Address - Fax:
Practice Address - Street 1:4885 HOFFMAN BLVD SUITE #300
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192
Practice Address - Country:US
Practice Address - Phone:847-428-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0318331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program