Healthcare Provider Details

I. General information

NPI: 1588813232
Provider Name (Legal Business Name): SANDRA ELLIOTT MACHIELS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TAMC, DEPT. OF PSYCHOLOGY
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD TAMC, DEPT. OF PSYCHOLOGY
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-1498
  • Fax:
Mailing address:
  • Phone: 808-433-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 1042
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 25533
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: