Provider Demographics
NPI:1023678109
Name:DZIUBAN, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:DZIUBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3876
Mailing Address - Country:US
Mailing Address - Phone:808-944-0422
Mailing Address - Fax:808-944-0421
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 212
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3876
Practice Address - Country:US
Practice Address - Phone:808-944-0422
Practice Address - Fax:808-944-0421
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X
HI153-841-0496-01376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion