Provider Demographics
NPI:1841419025
Name:RUSSELL, SHAUNA KA'IULANI (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:KA'IULANI
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:KA'IULANI
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 6783
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8934
Mailing Address - Country:US
Mailing Address - Phone:808-935-5255
Mailing Address - Fax:808-961-9044
Practice Address - Street 1:740 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4234
Practice Address - Country:US
Practice Address - Phone:808-935-5255
Practice Address - Fax:808-961-9044
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3052225100000X, 225100000X
FLPT22646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI289389OtherHMSA