Provider Demographics
NPI:1588997621
Name:SHETI, DRILONA (DDS)
Entity type:Individual
Prefix:
First Name:DRILONA
Middle Name:
Last Name:SHETI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DRILONA
Other - Middle Name:
Other - Last Name:KELLICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4533
Mailing Address - Country:US
Mailing Address - Phone:718-255-6193
Mailing Address - Fax:
Practice Address - Street 1:2120 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4533
Practice Address - Country:US
Practice Address - Phone:718-255-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054487122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist