Provider Demographics
NPI:1891868873
Name:NAKAO, SANDRA SHIZUE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SHIZUE
Last Name:NAKAO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 KILAUEA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2948
Mailing Address - Country:US
Mailing Address - Phone:808-969-7072
Mailing Address - Fax:808-969-7072
Practice Address - Street 1:278 KILAUEA AVENUE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2948
Practice Address - Country:US
Practice Address - Phone:808-969-7072
Practice Address - Fax:808-969-7072
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000256511OtherHMSA
HI0912676OtherUNIVERSITY HEALTH ALLIANC
101383Medicare ID - Type Unspecified