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General NPI Number Information
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NPI Number | 1619690385
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Entity Type | Individual
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Provider Name | SHAYNE BROOKS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 500 ALA MOANA BLVD STE 7400
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City | HONOLULU
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State | HI
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Zip | 96813-4902
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Country | US
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Telephone | 808-480-9873
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Fax |
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Provider Business Mailing Address
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Address Line | 15-2714 PAHOA VILLAGE RD STE H1 #217
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City | PAHOA
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State | HI
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Zip | 96778
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Country | US
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Telephone | 808-480-9873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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