Provider Demographics
NPI:1154460137
Name:DELA PENA, SHARON (RD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DELA PENA
Suffix:
Gender:F
Credentials:RD
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 3990
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-6990
Mailing Address - Country:US
Mailing Address - Phone:808-240-0100
Mailing Address - Fax:808-245-8867
Practice Address - Street 1:4643B WAIMEA CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-240-0100
Practice Address - Fax:808-338-1606
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI818760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI523979-01Medicaid
HI523979-01Medicaid
HIPENDINGMedicare UPIN