Active NPI
Shiju Cherian
- Endodontics
- Lake Mary, FL
National Provider Identifier
1306164876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN18944
- Practice address
- 311 S Dover CT
Lake Mary, FL 32746-4326 - Phone
- (561) 853-5666
- NPI assigned
- May 9, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN18944 | FL | Primary |
Addresses
Primary practice location
311 S Dover CT
Lake Mary, FL 32746-4326
Mailing address
311 S Dover CT
Lake Mary, FL 32746-4326
Phone (561) 853-5666
Other practice location 1
158 Villa Di Este Ter
Unit # 112
Lake Mary, FL 32746-1641
Phone (561) 853-5666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150518000937 | FL | Order and Referring Only - Other (Physician) | 6103146048 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN18944 | FL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1306164876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 S DOVER CT",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327464326",
"telephone_number": "561-853-5666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 S DOVER CT",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327464326",
"telephone_number": "561-853-5666"
}
],
"practiceLocations": [
{
"address_1": "158 Villa Di Este Ter",
"address_2": "Unit # 112",
"address_purpose": "LOCATION",
"city": "Lake Mary",
"state": "FL",
"postal_code": "327461641",
"country_code": "US",
"telephone_number": "561-853-5666",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHERIAN",
"first_name": "SHIJU",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-09",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN18944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.