Healthcare Provider Details

I. General information

NPI: 1801840525
Provider Name (Legal Business Name): SHEAREEN GEDAYLOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 KINOOLE ST STE 103
HILO HI
96720-4171
US

IV. Provider business mailing address

PO BOX 1557
HILO HI
96721-1557
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-3627
  • Fax: 808-696-3852
Mailing address:
  • Phone: 808-935-1193
  • Fax: 808-969-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13705
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: