Basic Information
Provider Information
NPI: 1386737138
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAYLOR
FirstName: SHAUNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 229 HAILI STREET
Address2:  
City: HILO
State: HI
PostalCode: 96720
CountryCode: US
TelephoneNumber: 8089614071
FaxNumber:  
Practice Location
Address1: 1178 KINOOLE ST
Address2:  
City: HILO
State: HI
PostalCode: 967207206
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber: 8089614795
Other Information
ProviderEnumerationDate: 10/02/2006
LastUpdateDate: 09/05/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD 17410HIY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XMD2005-0763NMN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
1033306105NM MEDICAID


Home