Provider Demographics
NPI:1699185728
Name:CHING, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CHING
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 1:560 N NIMITZ HWY
Mailing Address - Street 2:SUITE 114B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 N NIMITZ HWY
Practice Address - Street 2:SUITE 114B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5330
Practice Address - Country:US
Practice Address - Phone:808-591-1173
Practice Address - Fax:808-591-1174
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0-14-5902103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst