Healthcare Provider Details

I. General information

NPI: 1306528286
Provider Name (Legal Business Name): SHALYN R ROSEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 KOLOA RD # 2F
KOLOA HI
96756-9421
US

IV. Provider business mailing address

PO BOX 1216
KALAHEO HI
96741-1216
US

V. Phone/Fax

Practice location:
  • Phone: 808-639-0622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: