=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194291500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS SHANTELLE AGLANAO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2018
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 BRANNON ROAD BLDG 690
-----------------------------------------------------
City | SCHOFIELD BARRACKS
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96857-5617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-295-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91-209 KOLILI PL
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-699-4179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MHC-972
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------