Healthcare Provider Details

I. General information

NPI: 1083405542
Provider Name (Legal Business Name): SHANZIE MORIAH TIQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 07/25/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 ALA LILIKOI ST APT 604
HONOLULU HI
96818
US

IV. Provider business mailing address

955 ALA LILIKOI ST APT 604 955 ALA LILIKOI ST APT 604
HONOLULU HI
96818
US

V. Phone/Fax

Practice location:
  • Phone: 808-436-8488
  • Fax:
Mailing address:
  • Phone: 808-436-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: