Healthcare Provider Details

I. General information

NPI: 1164665089
Provider Name (Legal Business Name): SHERRY JUN GRACEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-115 AIEA HEIGHTS DR STE 225 #292
AIEA HI
96701
US

IV. Provider business mailing address

99-115 AIEA HEIGHTS DR. STE 225, #292
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-864-5444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1112
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: