Provider Demographics
NPI:1700821667
Name:SHEU, SHANNON MEI YEN (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MEI YEN
Last Name:SHEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 703
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-949-7568
Practice Address - Fax:808-941-3112
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84024207N00000X
HIMD 15383207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A840240Medicaid
CA00A840240Medicare PIN
CA00A840240Medicaid