Provider Demographics
NPI:1407075625
Name:MIYASHIRO, MISTY L I (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:L I
Last Name:MIYASHIRO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3244
Mailing Address - Country:US
Mailing Address - Phone:808-236-1529
Mailing Address - Fax:808-236-0844
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3244
Practice Address - Country:US
Practice Address - Phone:808-236-1529
Practice Address - Fax:808-236-0844
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 8351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist