Provider Demographics
NPI:1609193085
Name:BALA, SHIERALYN P
Entity Type:Individual
Prefix:MISS
First Name:SHIERALYN
Middle Name:P
Last Name:BALA
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 1:94-945 LUMILOKE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3947
Mailing Address - Country:US
Mailing Address - Phone:808-671-1351
Mailing Address - Fax:808-671-1351
Practice Address - Street 1:94-945 LUMILOKE ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3947
Practice Address - Country:US
Practice Address - Phone:808-671-1351
Practice Address - Fax:808-671-1351
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW04530192-01172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIW04530192-01Medicaid