Healthcare Provider Details

I. General information

NPI: 1457312860
Provider Name (Legal Business Name): RITA J SHUFORD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: RITA J ROBERTSON

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE SUITE A312
KAILUA HI
96734-1866
US

IV. Provider business mailing address

820 MILILANI STREET C/O SMA BILLING SOLUTIONS, LLP, SUITE 702A
HONOLULU HI
96813-2918
US

V. Phone/Fax

Practice location:
  • Phone: 808-375-8747
  • Fax: 808-254-6786
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY595
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: