Provider Demographics
NPI:1114697836
Name:NICHOLS, SHAYLAH (BS)
Entity Type:Individual
Prefix:
First Name:SHAYLAH
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2065
Mailing Address - Country:US
Mailing Address - Phone:808-380-1129
Mailing Address - Fax:
Practice Address - Street 1:1632 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2065
Practice Address - Country:US
Practice Address - Phone:808-380-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program