Provider Demographics
NPI:1497108765
Name:EBLACAS, JAMEYLEE BRANDYLYNN
Entity Type:Individual
Prefix:MS
First Name:JAMEYLEE
Middle Name:BRANDYLYNN
Last Name:EBLACAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JAMEYLEE
Other - Middle Name:BRANDYLYNN
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160B CHONG ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6739
Mailing Address - Country:US
Mailing Address - Phone:808-313-2172
Mailing Address - Fax:
Practice Address - Street 1:160B CHONG ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6739
Practice Address - Country:US
Practice Address - Phone:808-313-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst