Provider Demographics
NPI:1861493033
Name:SIGUR, SHELLEY A (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:SIGUR
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 1:220 W BRAMBLETON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1571
Mailing Address - Country:US
Mailing Address - Phone:615-400-0018
Mailing Address - Fax:
Practice Address - Street 1:220 W BRAMBLETON AVE STE 111
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1571
Practice Address - Country:US
Practice Address - Phone:615-400-0018
Practice Address - Fax:912-732-1013
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-04-24
Deactivation Date:2019-07-01
Deactivation Code:
Reactivation Date:2019-07-19
Provider Licenses
StateLicense IDTaxonomies
GADN012297122300000X
TNDS69641223G0001X
AL6712-C1223G0001X
VA0401418762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003239553AMedicaid
TN3205657Medicaid