Provider Demographics
NPI:1184218042
Name:CHANG, SHARON SAULAN (MSN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SAULAN
Last Name:CHANG
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 KILANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1559
Mailing Address - Country:US
Mailing Address - Phone:808-225-1946
Mailing Address - Fax:
Practice Address - Street 1:394 GLENNAN ROAD
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-8199
Practice Address - Fax:808-433-8334
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI60479163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI60479OtherBRAIN INJURY CLINIC