Provider Demographics
NPI:1578072963
Name:MACHADO, ANNELISA
Entity Type:Individual
Prefix:MS
First Name:ANNELISA
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 DOLE ST APT 1201
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4800
Mailing Address - Country:US
Mailing Address - Phone:786-879-4887
Mailing Address - Fax:
Practice Address - Street 1:1635 DOLE STREET
Practice Address - Street 2:HONOLULU
Practice Address - City:HAWAII
Practice Address - State:HI
Practice Address - Zip Code:33193-5827
Practice Address - Country:US
Practice Address - Phone:786-879-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-812103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty