Healthcare Provider Details

I. General information

NPI: 1942149778
Provider Name (Legal Business Name): SHANETTE KANANIMAULOA N. DIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 240166
HONOLULU HI
96824-0166
US

IV. Provider business mailing address

PO BOX 240166
HONOLULU HI
96824-0166
US

V. Phone/Fax

Practice location:
  • Phone: 808-927-5148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5338
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: