Provider Demographics
NPI:1184357592
Name:ELLIS, CHERYNE
Entity type:Individual
Prefix:
First Name:CHERYNE
Middle Name:
Last Name:ELLIS
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 1:170 ABBOTT ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-7800
Mailing Address - Country:US
Mailing Address - Phone:575-219-2049
Mailing Address - Fax:
Practice Address - Street 1:1390 MILLER ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2403
Practice Address - Country:US
Practice Address - Phone:575-219-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician