MEDICARE: REALSHIFT MENTAL HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1063232098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REALSHIFT MENTAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	3018 ALENCASTRE PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-1910
Country	:	US
Telephone Number	:	678-938-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-3575 KAULUAKOKO ST UNIT 1606
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5862
Country	:	US
Telephone Number	:	678-938-1585
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. SHARIKA LABRIE
Credential	:	NP
Telephone Number	:	678-938-1585

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	05/13/2025

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