Provider Demographics
NPI:1881367183
Name:MCKINLAY, SHANTHA
Entity type:Individual
Prefix:DR
First Name:SHANTHA
Middle Name:
Last Name:MCKINLAY
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 1:1003 BISHOP ST STE 380
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6409
Mailing Address - Country:US
Mailing Address - Phone:808-528-1717
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 380
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6409
Practice Address - Country:US
Practice Address - Phone:808-528-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIPSY-1955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program