Provider Demographics
NPI:1285718411
Name:HAM, SHELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:MD
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 10840
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5840
Mailing Address - Country:US
Mailing Address - Phone:808-934-7355
Mailing Address - Fax:808-935-3209
Practice Address - Street 1:169 PUUEO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2432
Practice Address - Country:US
Practice Address - Phone:808-934-7355
Practice Address - Fax:808-935-3209
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD89852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002275-02Medicaid
HI002275-02Medicaid