Basic Information
| Provider Information | |||||||||
| NPI: | 1366492860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64-1032 MAMALAHOA HWY | ||||||||
| Address2: | STE 306 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967438441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089691427 | ||||||||
| FaxNumber: | 8089614795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120A MAKAWAO AVE | ||||||||
| Address2: | |||||||||
| City: | MAKAWAO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967689448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085732222 | ||||||||
| FaxNumber: | 8088293673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD221 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.