MEDICARE: SHAWNA UEYAMA PSY.D., BCBA-D

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	103K00000X	Behavior Analyst	211	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	626467	OTHER		MHN PROVIDER ID (TRICARE)

General Provider Information

NPI Number	:	1134622574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA UEYAMA PSY.D., BCBA-D

Provider Business Mailing Address
First Line	:	590 FARRINGTON HWY UNIT 524
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2034
Country	:	US
Telephone Number	:	808-628-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 FARRINGTON HWY UNIT 524
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2034
Country	:	US
Telephone Number	:	808-628-0348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	07/17/2018

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