Provider Demographics
NPI:1063883429
Name:TSUKAYAMA, SHARI M (LAC)
Entity type:Individual
Prefix:MS
First Name:SHARI
Middle Name:M
Last Name:TSUKAYAMA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893391
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-0391
Mailing Address - Country:US
Mailing Address - Phone:808-699-0155
Mailing Address - Fax:
Practice Address - Street 1:94-1040 WAIPIO UKA ST
Practice Address - Street 2:SUITE #6
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4009
Practice Address - Country:US
Practice Address - Phone:808-699-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist