Provider Demographics
NPI:1093376337
Name:BASSILI, SHELBY
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:BASSILI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:FUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1243 ALA KAPUNA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1243 ALA KAPUNA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1266
Practice Address - Country:US
Practice Address - Phone:757-477-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst