Healthcare Provider Details

I. General information

NPI: 1255999520
Provider Name (Legal Business Name): STEPHANIE CORNELL PYSKIR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DIANE CORNELL

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA ST FL 7
HONOLULU HI
96813-2409
US

IV. Provider business mailing address

1356 LUSITANA ST FL 7
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-7689
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: