Provider Demographics
NPI:1457312860
Name:SHUFORD, RITA J (PHD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:J
Last Name:SHUFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:J
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:820 MILILANI STREET
Mailing Address - Street 2:C/O SMA BILLING SOLUTIONS, LLP, SUITE 702A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2918
Mailing Address - Country:US
Mailing Address - Phone:808-523-9363
Mailing Address - Fax:808-523-9418
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE A312
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-375-8747
Practice Address - Fax:808-254-6786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY595103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101094Medicare ID - Type Unspecified