Provider Demographics
NPI:1497765879
Name:TAKUSHI-ISARA, SHERRIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERRIE
Middle Name:M
Last Name:TAKUSHI-ISARA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHERRIE
Other - Middle Name:M
Other - Last Name:TAKUSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-1146
Mailing Address - Country:US
Mailing Address - Phone:808-484-2181
Mailing Address - Fax:808-484-2181
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 606
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-484-2181
Practice Address - Fax:808-484-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5161802Medicaid
HIBT414AMedicare PIN