Provider Demographics
NPI:1801840525
Name:GEDAYLOO, SHEAREEN (MD)
Entity Type:Individual
Prefix:
First Name:SHEAREEN
Middle Name:
Last Name:GEDAYLOO
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:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-1557
Mailing Address - Country:US
Mailing Address - Phone:808-935-1193
Mailing Address - Fax:808-969-1224
Practice Address - Street 1:1248 KINOOLE ST STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4171
Practice Address - Country:US
Practice Address - Phone:808-885-3627
Practice Address - Fax:808-696-3852
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HII69856Medicare UPIN
HIH102253Medicare PIN
HIH102251Medicare PIN
HIH102252Medicare PIN
HIH102206Medicare PIN