Healthcare Provider Details

I. General information

NPI: 1457102352
Provider Name (Legal Business Name): SHANYN FAFARD-KAAIHUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-001 KAMEHAMEHA HWY STE 301
KANEOHE HI
96744-3777
US

IV. Provider business mailing address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-234-2240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN-78672
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: