Healthcare Provider Details

I. General information

NPI: 1194291500
Provider Name (Legal Business Name): MRS. SHANTELLE NAKAAHIKI LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SHANTELLE AGLANAO

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-209 KOLILI PL
KAPOLEI HI
96707-2605
US

IV. Provider business mailing address

91-1079 NAMAHOE ST # 8F
KAPOLEI HI
96707-2781
US

V. Phone/Fax

Practice location:
  • Phone: 385-423-4840
  • Fax:
Mailing address:
  • Phone: 808-699-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-972
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: