Provider Demographics
NPI:1801239652
Name:SHIRO, JOCELYN
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:SHIRO
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 1:45035 KANEOHE BAY DRIVE
Mailing Address - Street 2:A
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-234-5353
Mailing Address - Fax:808-235-5858
Practice Address - Street 1:45-035 KANEOHE BAY DR
Practice Address - Street 2:A
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2417
Practice Address - Country:US
Practice Address - Phone:808-234-5353
Practice Address - Fax:808-235-5858
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK684225100000X
HI4068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist