Healthcare Provider Details

I. General information

NPI: 1366014656
Provider Name (Legal Business Name): JADA AULIILANI MCCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL #5002
KAILUA HI
96734
US

IV. Provider business mailing address

94-392 NUI ST
MILILANI HI
96789-2618
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax: 808-427-3472
Mailing address:
  • Phone: 808-354-4576
  • 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: