Provider Demographics
NPI:1326430968
Name:SHAYNE CASTANERA MD CORP
Entity Type:Organization
Organization Name:SHAYNE CASTANERA MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-254-4670
Mailing Address - Street 1:PO BOX 5008
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-9008
Mailing Address - Country:US
Mailing Address - Phone:808-254-4670
Mailing Address - Fax:808-254-4670
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-254-4670
Practice Address - Fax:808-254-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07052002Medicaid
HIH0091655OtherHMSA
HIH0091655OtherHMSA