=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093639080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIFAA SALEK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2026
-----------------------------------------------------
Last Update Date | 08/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 354 ULUNIU ST STE 404
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-688-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 LUNALILO HOME RD UNIT 6102
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96825-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-688-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | USAMA S EDRIS
-----------------------------------------------------
Credential | RPH,LMT
-----------------------------------------------------
Telephone | 808-688-8680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------