Provider Demographics
NPI:1194291500
Name:AGLANAO, SHANTELLE
Entity type:Individual
Prefix:MISS
First Name:SHANTELLE
Middle Name:
Last Name:AGLANAO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANTELLE
Other - Middle Name:
Other - Last Name:AGLANAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:91-209 KOLILI PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2605
Mailing Address - Country:US
Mailing Address - Phone:808-699-4179
Mailing Address - Fax:
Practice Address - Street 1:310 BRANNON ROAD
Practice Address - Street 2:BLDG 690
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857-5617
Practice Address - Country:US
Practice Address - Phone:808-295-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-972101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health