Provider Demographics
NPI:1619402104
Name:MACHADO, WHITNEY K
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:K
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 1:4282 OMAO RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-8639
Mailing Address - Country:US
Mailing Address - Phone:808-635-5952
Mailing Address - Fax:
Practice Address - Street 1:3-3367 KUHIO HWY
Practice Address - Street 2:UNIT #211
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1034
Practice Address - Country:US
Practice Address - Phone:808-635-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician