Provider Demographics
NPI:1184347411
Name:VALENZUELA, SHANA KRISTINE IKEDA (BACB 1-21-49139)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:KRISTINE IKEDA
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:BACB 1-21-49139
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 ALA PILI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1624
Mailing Address - Country:US
Mailing Address - Phone:808-216-4476
Mailing Address - Fax:
Practice Address - Street 1:825 MANZELMAN CIR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-4733
Practice Address - Country:US
Practice Address - Phone:808-307-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA533103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst