Healthcare Provider Details

I. General information

NPI: 1689029027
Provider Name (Legal Business Name): ERIK MASAYUKI SHIPLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE STE 208
HONOLULU HI
96816-5312
US

IV. Provider business mailing address

4211 WAIALAE AVE STE 208
HONOLULU HI
96816-5312
US

V. Phone/Fax

Practice location:
  • Phone: 808-888-5228
  • Fax:
Mailing address:
  • Phone: 808-888-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAM3582269-653
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-21100
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: