Provider Demographics
NPI:1558927780
Name:VALENCIA, SHELLA MARIE TAGUDIN (CNA)
Entity Type:Individual
Prefix:
First Name:SHELLA MARIE
Middle Name:TAGUDIN
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-470 OPEHA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4516
Mailing Address - Country:US
Mailing Address - Phone:808-222-5485
Mailing Address - Fax:808-762-4214
Practice Address - Street 1:94-470 OPEHA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4516
Practice Address - Country:US
Practice Address - Phone:808-222-5485
Practice Address - Fax:808-762-4214
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-190030311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home