Provider Demographics
NPI:1083262182
Name:KEALOHA, SHAIANNE
Entity Type:Individual
Prefix:
First Name:SHAIANNE
Middle Name:
Last Name:KEALOHA
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 1:2855 E MANOA ROAD STE 105 #281
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822
Mailing Address - Country:US
Mailing Address - Phone:808-840-3396
Mailing Address - Fax:
Practice Address - Street 1:2855 E MANOA ROAD STE 105 #281
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-840-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-01
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-19-97562106S00000X
HIBA-768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician