Healthcare Provider Details

I. General information

NPI: 1942355896
Provider Name (Legal Business Name): SHELLY A TOMISHIMA PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 906
HONOLULU HI
96814-4405
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-943-0200
  • Fax: 808-943-8833
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number747
License Number StateHI

VIII. Authorized Official

Name: SHELLY TOMISHIMA
Title or Position: OWNER
Credential: PHD
Phone: 808-943-0200