Provider Demographics
NPI:1750066916
Name:STANFORD, SHAKAYLA CA'LEXIS
Entity type:Individual
Prefix:
First Name:SHAKAYLA
Middle Name:CA'LEXIS
Last Name:STANFORD
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 1:5294 CATLIN LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3478
Mailing Address - Country:US
Mailing Address - Phone:254-535-1727
Mailing Address - Fax:
Practice Address - Street 1:5294 CATLIN LN
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3478
Practice Address - Country:US
Practice Address - Phone:254-535-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician