Provider Demographics
NPI:1962457317
Name:SHANKS, SHERI SLOGGETT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:SLOGGETT
Last Name:SHANKS
Suffix:
Gender:F
Credentials:PSYD
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 25685
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0685
Mailing Address - Country:US
Mailing Address - Phone:808-735-2494
Mailing Address - Fax:866-334-4352
Practice Address - Street 1:1 KEAHOLE PL APT 2208
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3418
Practice Address - Country:US
Practice Address - Phone:808-735-2494
Practice Address - Fax:866-334-4352
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0024OtherHMSA PROVIDER #