Provider Demographics
NPI:1376127142
Name:YAMAMOTO, SHANNAN AKIKO
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:AKIKO
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1813 KILEKA PL
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-1605
Mailing Address - Country:US
Mailing Address - Phone:808-754-1003
Mailing Address - Fax:
Practice Address - Street 1:98-1813 KILEKA PL
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-1605
Practice Address - Country:US
Practice Address - Phone:808-754-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health