Provider Demographics
NPI:1114274610
Name:VILLENA, SHEILLA-MARY AGBAYANI (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHEILLA-MARY
Middle Name:AGBAYANI
Last Name:VILLENA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10114
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5114
Mailing Address - Country:US
Mailing Address - Phone:808-987-3086
Mailing Address - Fax:
Practice Address - Street 1:93 BANYAN DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4632
Practice Address - Country:US
Practice Address - Phone:808-987-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist