Provider Demographics
NPI:1548383433
Name:SHANAHAN, ROSWITHA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSWITHA
Middle Name:J
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821A CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2330
Mailing Address - Country:US
Mailing Address - Phone:808-277-7040
Mailing Address - Fax:
Practice Address - Street 1:821A CEDAR ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2330
Practice Address - Country:US
Practice Address - Phone:808-277-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49945102Medicaid
HI49945102Medicaid