Provider Demographics
NPI:1043779408
Name:SHAUL, HAILEY
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:SHAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1167 HAMANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3946
Mailing Address - Country:US
Mailing Address - Phone:808-729-1487
Mailing Address - Fax:
Practice Address - Street 1:94-1221 KA UKA BLVD STE 106
Practice Address - Street 2:#167
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6299
Practice Address - Country:US
Practice Address - Phone:903-819-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-19-81353106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician