Provider Demographics
NPI:1215385562
Name:KODAMA, SHARYN (ATC, EMT)
Entity Type:Individual
Prefix:
First Name:SHARYN
Middle Name:
Last Name:KODAMA
Suffix:
Gender:F
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1200 MEHEULA PKWY
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1748
Mailing Address - Country:US
Mailing Address - Phone:808-307-4392
Mailing Address - Fax:808-627-7369
Practice Address - Street 1:95-1200 MEHEULA PKWY
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1748
Practice Address - Country:US
Practice Address - Phone:808-307-4392
Practice Address - Fax:808-627-7369
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer