Provider Demographics
NPI:1609228444
Name:AYONON, SHANNON M (MAT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:AYONON
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-429 KIOE ST
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9631
Mailing Address - Country:US
Mailing Address - Phone:808-352-2677
Mailing Address - Fax:
Practice Address - Street 1:67-429 KIOE ST
Practice Address - Street 2:
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9631
Practice Address - Country:US
Practice Address - Phone:808-352-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT14274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist