Provider Demographics
NPI:1134622574
Name:UEYAMA, SHAWNA (PSYD, BCBA-D)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:UEYAMA
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FARRINGTON HWY UNIT 524
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2034
Mailing Address - Country:US
Mailing Address - Phone:808-628-0348
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY UNIT 524
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2034
Practice Address - Country:US
Practice Address - Phone:808-628-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
626467OtherMHN PROVIDER ID (TRICARE)