Provider Demographics
NPI:1972666105
Name:SHIELDS, HAWKEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HAWKEN
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:M
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 1546
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1546
Mailing Address - Country:US
Mailing Address - Phone:808-640-0645
Mailing Address - Fax:
Practice Address - Street 1:76-5914 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:HOLUALOA
Practice Address - State:HI
Practice Address - Zip Code:96725
Practice Address - Country:US
Practice Address - Phone:808-640-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57177001Medicaid
HI57177001Medicaid